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Abstract Background The western province of Anbar, and the district of Hadeetha, have suffered direct impacts from the second United States led invasion (2003) through the ISIS invasion (2014–2017). With the primary health care centers being closed or inaccessible, the remaining population experienced changes in health seeking. The area of Anbar, Iraq remains largely remote from the discourse of health system recovery post-conflict. The objective of this study was to describe changes in health seeking behaviors of caregivers of children ages 12–72 months of age in Hadeetha, Anbar, Iraq from the conflict period of ISIS (Islamic State of Syria and Iraq), 2014–2017, to the post-conflict period, 2021. Methods This was a mixed-methods study composed of a cross-sectional 415 household survey and focus groups in Hadeetha, Anbar, Iraq. Caretakers of children were interviewed from February to April 2021. Children were sampled from a list of children who missed at least one vaccination appointment without a return for follow-up from the birth cohorts of 2014 to 2020. Healthcare workers focus groups and key informant interviews occurred from 2019 to 2021 centered around experiences from the 2014 to 2021 period. Results In the post-conflict period, there were no differences in health seeking based upon provider type between respondents. Physicians were primary healthcare providers in the post-conflict period for 79% of respondents versus only 47% in the conflict period. Healthcare workers described major barriers to delivering services in Hadeetha during the ISIS occupation due to infrastructure damage, threats of violence, decreased medical personnel, lack of compensation and disruptions in medical supplies from 2014 to 2017. Conclusion This study provides insight into health seeking challenges among the many individuals who remained in Hadeetha during the ISIS occupation. Health use patterns by provider type mirror the concerns the healthcare providers shared: limited availability, efflux of professional workers, limited resources and security challenges to providing care. Positive trends toward increased access to physicians during periods of peace are an encouraging marker for continued population resilience during the post-conflict period. Recovery efforts continue to be hampered by internal sectarian discord within Iraq as well as insufficient resources to maintain health services as well as provide catch-up health services, such as immunizations.

BACKGROUND Migrants tend to have an increased risk of physical and mental ill health, but less access to health care services. Hence this study was conducted with the following objectives: to describe the health problems among Migrant construction workers in Chennai, to determine the quality of life of Migrant construction workers in Chennai and to assess the Health seeking behaviour of Migrant construction workers in Chennai METHODS This was a community based Cross-sectional study conducted in construction sites in Chennai. Interstate migrant construction laborers including men and women aged more than 18 years who are working in the construction sites for more than 1 year were included in the study. The study was conducted from March to April 2023. Sample size was calculated to be 400 and convenient sampling was used. Structured and pretested Validated Questionnaire was used for data collection. RESULT: The study showed that 13% had respiratory disease, 5.1% had acute febrile illness and 5.1 % had gastrointestinal disease. About 13% of the respondents went to nearby medical shop when they have any medical problems. About 41% of the repondents had poor QOL and quality of life was very poor in 5% of the respondents.

Background: Early recognition of neonatal illnesses followedby care-seeking and intervention are key factors in improving neonatal health and survival. Objectives: To assess mothers’ ability to recognize newborn danger signs and actions taken by mothers in the event of neonatal illness. Methods: The study was carried out in three health centres in Yenagoa Metropolis from April to May 2011. A 15 itemed Questionnaire based on the WHO/UNICEF IMCI programme handbook was administered to 146 mothers with infants younger than three months. The mothers were asked to identify danger signs of neonatal illness from a list of symptoms, to indicate which of the listed symptoms their babies experienced, to state what actions were taken in response to the symptoms and reasons for not utilizing orthodox healthcare. Results: None of the listed symptoms was recognized by up to half the mothers as danger signs of neonatal illness, the best being fast breathing by 66 (45.2%) mothers. Eighty two (56.2%) mothers reported that their children experienced some of the neonatal danger signs: the commonest were difficult breathing and convulsions in 8 (9.8%) cases each. Unconsciousness and excessive crying were thought to be caused by evil spirits and consultations sought with faith healers. The major constraint to utilization of health facilities was cost {45(29.8%)}. Conclusion: Mothers’ recognition of danger signs in the newborn was poor. Self-medication and the use of home remedies delayed timely consultation. The commonest reason for non-utilization of health facilities was lack of money.

Background There is a lack of research evidence on the quantitative relationship between symptom burden and health care seeking among individuals with presumptive tuberculosis (TB). Methods Data were derived from a cross-sectional population-based TB survey conducted between February 2021 and July 2022 in 32 districts of India. Eligible and consented participants (age >15 years) underwent TB symptom screening and history elicitation. Fairlie decomposition analysis was used to estimate the net differences in health care seeking due to varied symptom burden—from 1+ burden (>1 symptom) to 4+ burden (>4 symptoms)—and decomposed by observable covariates based on logit models with 95% CIs. Results Of the 130 932 individuals surveyed, 9540 (7.3%) reported at least 1 recent TB symptom, of whom 2678 (28.1%; 95% CI, 27.1%–28.9%) reportedly sought health care. The net differences in health care seeking among persons with symptom burden 1+ to 4+ ranged from 6.6 percentage points (95% CI, 4.8–8.4) to 7.7 (95% CI, 5.2–10.2) as compared with persons with less symptom burden. The presence of expectoration, fatigue, and loss of appetite largely explained health care seeking (range, 0.9–3.1 percentage points [42.89%–151.9%]). The presence of fever, cough, past TB care seeking, weight loss, and chest pain moderately explained (range, 5.3%–25.3%) health care seeking. Conclusions Increased symptom burden and symptoms other than the commonly emphasized cough and fever largely explained health care seeking. Orienting TB awareness and risk communications toward symptom burden and illness perceptions could help address population gaps in health care seeking for TB. [ABSTRACT FROM AUTHOR]

Abstract Background Despite the high burden of perinatal depression in Nepal, the detection rate is low. Community-based strategies such as sensitization programmes and the Community Informant Detection Tool (CIDT) have been found to be effective in raising awareness and thus promoting the identification of mental health problems. This study aims to adapt these community strategies for perinatal depression in the Nepalese context. Methods We followed a four-step process to adapt the existing community sensitization program manual and CIDT. Step 1 included in-depth interviews with women identified with perinatal depression (n=36), and focus group discussions were conducted with health workers trained in community mental health (n=13), female community health volunteers (FCHVs), cadre of Nepal government for the prevention and promotion of community maternal and child health (n=16), and psychosocial counsellors (n=5). We explored idioms and understanding of depression, perceived causes, and possible intervention. Step 2 included draft preparation based on the qualitative study. Step 3 included a one-day workshop with the psychosocial counsellors (n=2) and health workers (n=12) to assess the understandability and comprehensiveness of the draft and to refine the content. A review of the CIDT and community sensitization program manual by a psychiatrist was performed in Step 4. Results The first step led to the content development for the CIDT and community sensitization manual. Multiple stakeholders and experts reviewed and refined the content from the second to fourth steps. Idioms of depression and commonly cited risk factors were incorporated in the CIDT. Additionally, myths of perinatal depression and the importance of the role of family were added to the community sensitization manual. Conclusion Both the CIDT and community sensitization manual are grounded in the local context and are simple, clear, and easy to understand.

Background: Despite the high burden of perinatal depression in Nepal, the detection rate is low. Community-based strategies such as sensitization programmes and the Community Informant Detection Tool (CIDT) have been found to be effective in raising awareness and thus promoting the identification of mental health problems. This study aims to adapt these community strategies for perinatal depression in the Nepalese context. Methods: We followed a four-step process to adapt the existing community sensitization program manual and CIDT. Step 1 included in-depth interviews with women identified with perinatal depression (n=36), and focus group discussions were conducted with health workers trained in community mental health (n=13), female community health volunteers (FCHVs), cadre of Nepal government for the prevention and promotion of community maternal and child health (n=16), and psychosocial counsellors (n=5). We explored idioms and understanding of depression, perceived causes, and possible intervention. Step 2 included draft preparation based on the qualitative study. Step 3 included a one-day workshop with the psychosocial counsellors (n=2) and health workers (n=12) to assess the understandability and comprehensiveness of the draft and to refine the content. A review of the CIDT and community sensitization program manual by a psychiatrist was performed in Step 4. Results: The first step led to the content development for the CIDT and community sensitization manual. Multiple stakeholders and experts reviewed and refined the content from the second to fourth steps. Idioms of depression and commonly cited risk factors were incorporated in the CIDT. Additionally, myths of perinatal depression and the importance of the role of family were added to the community sensitization manual. Conclusion: Both the CIDT and community sensitization manual are grounded in the local context and are simple, clear, and easy to understand. [ABSTRACT FROM AUTHOR]

Background: Diabetes is a significant contributor to kidney failure, heart attack, strokes, lower limb amputation, blindness, and other complications that negatively impact health-related quality of life (HRQOL). This study assessed the HRQOL and clinical outcomes of patients with diabetes accessing healthcare in south-eastern Ghana. Methods: This was a hospital-based cross-sectional descriptive study conducted in the Ho Municipal and Ho Teaching Hospitals in Ghana among patients with type 2 diabetes who were seeking healthcare at both hospitals for at least 12 months. Systematic random sampling technique was used to select 310 respondents out of the total sample size of 326 patients with type 2 diabetes and data were collected using diabetes-39 questionnaire. The data were analysed using STATA 16.0. Socio-demographic and clinical variables were expressed as frequencies and percentages. Differences between proportions were tested using Chi-square to identify predictors of poor HRQOL and Pearson correlation for association. The p < 0.05 was considered significant. Results: Out of 310 respondents, 171 (55.0%) had poor HRQOL. The predictors of poor HRQOL were age (p < 0.008), education (p < 0.028), employment (p < 0.001), residence (p < 0.01), duration of diabetes (p < 0.002), diabetes education (p < 0.001), BMI (p < 0.005), and glycaemic control (p < 0.001). Energy and mobility (63.2%), anxiety and worry (53.9%), and diabetes control (49.6%) dimensions were the most prevalent of poor HRQOL. Diabetes education, complications, being diabetic for 16 years and above, earning income, resident in rural area, being married, being pensioner and national Service Personnel, and diabetes comorbidities were significantly associated with HRQOL. Conclusions: More than half of the respondents had poor HRQOL. Clinical and public health efforts should focus on effective control and screening measures for the individual patients and general population. [ABSTRACT FROM AUTHOR]

Background: Guardians’ involvement in the management of childhood illnesses plays a pivotal role in reducing mortality and morbidity among children under 5 years old. It is through the guardian’s eyes that the child can be afforded timely healthcare, prevented from contracting an illness and effectively taken prescribed medication. Aim: The study aimed to explore the guardians’ lived experiences in their involvement in managing childhood illnesses in Vhembe district, Limpopo province, South Africa. Setting: A qualitative, exploratory and descriptive study was conducted with 16 purposively sampled participants. Methods: One-on-one individual interviews were conducted with participants. Data were analysed following Braun and Clarke’s thematic analysis. Results: Guardians reported their involvement by seeking child healthcare in healthcare facilities when ill and due for immunisations. Involvement in childhood care is performed through assessment of child illness at home, follow-up, referral of children to healthcare facilities, promotion of child health and prevention of childhood illnesses. Conclusion: Children remain dependent on guardians for their well-being. Seeking care, preventing illnesses and promoting childhood health are vital in reducing child mortality and childhood morbidity. Contribution: Involving and empowering guardians regarding the care of children under 5 years old are vital in achieving Sustainable Development Goal number 3 in 2030.

Abstract Background Globally, non-communicable diseases (NCDs) are the leading cause of mortality and morbidity placing a huge burden on individuals, families and health systems, especially in low- and middle-income countries (LMICs). This rising disease burden calls for policy responses that engage the entire health care system. This study aims to synthesize evidence on how people with NCDs choose their healthcare providers in LMICs, and the outcomes of these choices, with a focus on private sector delivery. Methods A systematic search for literature following PRISMA guidelines was conducted. We extracted and synthesised data on the determinants and outcomes of private health care utilisation for NCDs in LMICs. A quality and risk of bias assessment was performed using the Mixed Methods Appraisal Tool (MMAT). Results We identified 115 studies for inclusion. Findings on determinants and outcomes were heterogenous, often based on a particular country context, disease, and provider. The most reported determinants of seeking private NCD care were patients having a higher socioeconomic status; greater availability of services, staff and medicines; convenience including proximity and opening hours; shorter waiting times and perceived quality. Transitioning between public and private facilities is common. Costs to patients were usually far higher in the private sector for both inpatient and outpatient settings. The quality of NCD care seems mixed depending on the disease, facility size and location, as well as the aspect of quality assessed. Conclusion Given the limited, mixed and context specific evidence currently available, adapting health service delivery models to respond to NCDs remains a challenge in LMICs. More robust research on health seeking behaviours and outcomes, especially through large multi-country surveys, is needed to inform the effective design of mixed health care systems that effectively engage both public and private providers. Trial registration PROSPERO registration number CRD42022340059 .

Background: Globally, non-communicable diseases (NCDs) are the leading cause of mortality and morbidity placing a huge burden on individuals, families and health systems, especially in low- and middle-income countries (LMICs). This rising disease burden calls for policy responses that engage the entire health care system. This study aims to synthesize evidence on how people with NCDs choose their healthcare providers in LMICs, and the outcomes of these choices, with a focus on private sector delivery. Methods: A systematic search for literature following PRISMA guidelines was conducted. We extracted and synthesised data on the determinants and outcomes of private health care utilisation for NCDs in LMICs. A quality and risk of bias assessment was performed using the Mixed Methods Appraisal Tool (MMAT). Results: We identified 115 studies for inclusion. Findings on determinants and outcomes were heterogenous, often based on a particular country context, disease, and provider. The most reported determinants of seeking private NCD care were patients having a higher socioeconomic status; greater availability of services, staff and medicines; convenience including proximity and opening hours; shorter waiting times and perceived quality. Transitioning between public and private facilities is common. Costs to patients were usually far higher in the private sector for both inpatient and outpatient settings. The quality of NCD care seems mixed depending on the disease, facility size and location, as well as the aspect of quality assessed. Conclusion: Given the limited, mixed and context specific evidence currently available, adapting health service delivery models to respond to NCDs remains a challenge in LMICs. More robust research on health seeking behaviours and outcomes, especially through large multi-country surveys, is needed to inform the effective design of mixed health care systems that effectively engage both public and private providers. Trial registration: PROSPERO registration number CRD42022340059. [ABSTRACT FROM AUTHOR]

Online health information seeking (OHIS) is understood by health care, health promotion, and disease prevention experts as a resource for healthy aging. It is particularly relevant for older adults since this population can benefit significantly from the accessibility and convenience of online health platforms and health information. Nevertheless, empirical findings regarding the acceptance, potentials, and barriers of OHIS among older adults are limited. This mini-review aims to explore the level of acceptance of OHIS, including passive reading of information and active interactions with peers, among the older population. Furthermore, it examines the potentials and barriers associated with such practices. The findings ultimately emphasize the evolving landscape of internet health information exploration among older adults and the potential advantages and challenges that may arise, especially in the context of active interactions with peers. [ABSTRACT FROM AUTHOR]

Online health information seeking (OHIS) is understood by health care, health promotion, and disease prevention experts as a resource for healthy aging. It is particularly relevant for older adults since this population can benefit significantly from the accessibility and convenience of online health platforms and health information. Nevertheless, empirical findings regarding the acceptance, potentials, and barriers of OHIS among older adults are limited. This mini-review aims to explore the level of acceptance of OHIS, including passive reading of information and active interactions with peers, among the older population. Furthermore, it examines the potentials and barriers associated with such practices. The findings ultimately emphasize the evolving landscape of internet health information exploration among older adults and the potential advantages and challenges that may arise, especially in the context of active interactions with peers.

Objective: Sociodemographic factors play a crucial role in shaping the health-seeking behaviors of individuals residing in slum areas, particularly in their choice of healthcare facilities. Recognizing the importance of strengthening the existing healthcare systems, this research project was undertaken with the primary objective of comprehending the health-seeking behaviors among residents of Mumbai's slum dwellings in India. To achieve this goal, a comprehensive cross-sectional community needs assessment was conducted spanning from October 2018 to January 2019. Results: 432 respondents reported utilizing at least one health facility in the past year. They reported using private hospitals (172), public hospitals (208), Community Health clinics [23], or other healthcare services (29). To gain further insights into the factors influencing these choices, logistic regression analysis was conducted. The analysis revealed that being female was found to be negatively associated with the selection of a general practitioner as a preferred healthcare provider. On the other hand, higher levels of education and income were found to have a positive association with the preference for private hospitals. Conversely, these factors were negatively associated with the choice of government hospitals. [ABSTRACT FROM AUTHOR]

Background/Aims: The prevalences of good knowledge and health-seeking practice for newborn danger signs are generally low in Asia and sub-Saharan African countries. There is limited information available about the effect of maternal and child health service use on this issue among mothers in Bahirdar. This study's aim was to assess the effect of service use on knowledge and health-seeking practice related to newborn danger signs among women with infants in Bahirdar. Methods: This community-based cross-sectional study involved 392 women with infants aged less than 6 months, who used maternal and child health services in Bahirdar between 10 September and 10 October 2020. Bivariable and multivariable regression were used to identify service use factors associated with health-seeking behaviour and knowledge related to newborn danger signs. Results: Most of the participants recognised that frequent vomiting (81.1%), high fever (73.0%) and convulsion (69.9%) were neonatal danger signs. Postnatal care counselling was strongly associated with health-seeking practice (adjusted odds ratio=1.9, P<0.001). Antenatal care counselling was strongly associated with knowledge of newborn danger signs (adjusted odds ratio=1.57, P<0.001). Conclusions: The prevalence of maternal knowledge of newborn danger signs was lower compared to the literature. Similarly, the prevalence of health-seeking practice among mothers with an infant with a newborn danger sign was low. Interventions to improve the quality of antenatal and postnatal counselling are recommended. [ABSTRACT FROM AUTHOR]

Background and Aims: Traditional medicines are one of Africa's primary response mechanisms to medical emergencies, while, in other communities, all healthcare decisions are based on indigenous traditions and beliefs. For millions of individuals who reside in rural areas throughout low‐ and middle‐income nations, those healers serve as their only primary healthcare practitioners. This study intends to examine the availability, preferences, and practices of traditional medicine seeking among the Sudanese of North Kordofan state. Method: A descriptive cross‐sectional study was carried out in two conveniently chosen localities in North Kordofan state, namely Barrah, and Shaikan. A structured questionnaire with three sections—sociodemographic, attitudes, and forms of traditional medical practices—was used for face‐to‐face interviews with the residents. The frequency (n) and percentage (%) of categorical data are presented. The Chi‐square and Fischer exact tests were performed to determine characteristics related to traditional medicine practice and the preferred type of medicine among participants; a p value of.05 was considered significant. Results: A total of 302 residents took part in the study, with the 15–30 age group constituting the majority. The majority of participants (89.1%) used traditional medicine, and the majority of them (92.4%) learned about it from their families. The major type of traditional medicine (60.3%) used was a medical herbs–herb practitioner. Cultural influences (57%) and the effectiveness of traditional medicines (48.3%) were the most common reasons for seeking those medicines. Conclusion: Most participants seek traditional medicine, with traditional herbs and holy recitation commonly used. Affordability, therapeutic effectiveness, and cultural and religious influence were reasons for preferring traditional medicine. [ABSTRACT FROM AUTHOR]

BackgroundHow 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.MethodsHousehold 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.ResultsAlmost 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  3.6 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.ConclusionIn 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.

Abstract Background In Myanmar, malaria still poses a significant burden for vulnerable populations particularly forest goers even though impressive progress has been made over the past decade. Limited evidence existed related to forest goers’ health-seeking behaviour and factors that drive decision making for providers’ choice to support national malaria programmes towards elimination. In response to that, this research is conducted to identify who they preferred and what are the factors associated with providers’ choice in malaria febrile illness and Rapid Diagnostic Testing (RDT). Methods A cross-sectional study applying quantitative household survey was completed with 479 forest goer households in 20 malaria endemic townships across Myanmar. The household data was collected with the types of providers that they consulted for recent and previous febrile episodes. To identify the factors associated with providers’ choices, univariate and multivariate multinomial logistic regressions were done using Stata version 14.1. Statistical significance was set as p = 0.05. Results A total of 307 individuals experienced fever within one month and 72.3% sought care from providers. Also, a total of 509 forest goers reported that they had a previous febrile episode and 62.6% received care from a provider. Furthermore, 56.2% said that they had RDT testing during these previous febrile illnesses. They consulted public facilities and public health staff, private facilities, private and semi-private providers, community health volunteers or workers in their residing village and those located outside their villages but majority preferred those within their villages. On multivariate analyses, second richest quintile (public, RRR = 12.9) (semi-private, RRR = 17.9), (outside, RRR = 8.4) and access to 4 and above nearby providers (public, RRR = 30.3) (semi-private, RRR = 1.5) (outside, RRR = 0.5) were found to be significantly associated with provider choice for recent fever episode. Similar findings were also found for previous febrile illness and RDT testing among forest goers. Conclusions It was highlighted in this study that in forest goer households, they preferred nearby providers and the decision to choose providers seemed to be influenced by their access to number of nearby providers and socio-economic status when they sought care from a provider regardless of fever occurrence location. It was important that the national programmes considere involving these nearby providers in elimination efforts.

Abstract Background and Aims Traditional medicines are one of Africa's primary response mechanisms to medical emergencies, while, in other communities, all healthcare decisions are based on indigenous traditions and beliefs. For millions of individuals who reside in rural areas throughout low‐ and middle‐income nations, those healers serve as their only primary healthcare practitioners. This study intends to examine the availability, preferences, and practices of traditional medicine seeking among the Sudanese of North Kordofan state. Method A descriptive cross‐sectional study was carried out in two conveniently chosen localities in North Kordofan state, namely Barrah, and Shaikan. A structured questionnaire with three sections—sociodemographic, attitudes, and forms of traditional medical practices—was used for face‐to‐face interviews with the residents. The frequency (n) and percentage (%) of categorical data are presented. The Chi‐square and Fischer exact tests were performed to determine characteristics related to traditional medicine practice and the preferred type of medicine among participants; a p value of.05 was considered significant. Results A total of 302 residents took part in the study, with the 15–30 age group constituting the majority. The majority of participants (89.1%) used traditional medicine, and the majority of them (92.4%) learned about it from their families. The major type of traditional medicine (60.3%) used was a medical herbs–herb practitioner. Cultural influences (57%) and the effectiveness of traditional medicines (48.3%) were the most common reasons for seeking those medicines. Conclusion Most participants seek traditional medicine, with traditional herbs and holy recitation commonly used. Affordability, therapeutic effectiveness, and cultural and religious influence were reasons for preferring traditional medicine.

Background: In Myanmar, malaria still poses a significant burden for vulnerable populations particularly forest goers even though impressive progress has been made over the past decade. Limited evidence existed related to forest goers' health-seeking behaviour and factors that drive decision making for providers' choice to support national malaria programmes towards elimination. In response to that, this research is conducted to identify who they preferred and what are the factors associated with providers' choice in malaria febrile illness and Rapid Diagnostic Testing (RDT). Methods: A cross-sectional study applying quantitative household survey was completed with 479 forest goer households in 20 malaria endemic townships across Myanmar. The household data was collected with the types of providers that they consulted for recent and previous febrile episodes. To identify the factors associated with providers' choices, univariate and multivariate multinomial logistic regressions were done using Stata version 14.1. Statistical significance was set as p = 0.05. Results: A total of 307 individuals experienced fever within one month and 72.3% sought care from providers. Also, a total of 509 forest goers reported that they had a previous febrile episode and 62.6% received care from a provider. Furthermore, 56.2% said that they had RDT testing during these previous febrile illnesses. They consulted public facilities and public health staff, private facilities, private and semi-private providers, community health volunteers or workers in their residing village and those located outside their villages but majority preferred those within their villages. On multivariate analyses, second richest quintile (public, RRR = 12.9) (semi-private, RRR = 17.9), (outside, RRR = 8.4) and access to 4 and above nearby providers (public, RRR = 30.3) (semi-private, RRR = 1.5) (outside, RRR = 0.5) were found to be significantly associated with provider choice for recent fever episode. Similar findings were also found for previous febrile illness and RDT testing among forest goers. Conclusions: It was highlighted in this study that in forest goer households, they preferred nearby providers and the decision to choose providers seemed to be influenced by their access to number of nearby providers and socio-economic status when they sought care from a provider regardless of fever occurrence location. It was important that the national programmes considere involving these nearby providers in elimination efforts. [ABSTRACT FROM AUTHOR]

Snakebite envenoming is an acute medical emergency which affects hundreds of thousands of people worldwide, primarily in remote rural areas of low-and middle income countries in the Global South. A considerable proportion of snakebite patients turn to traditional healers (THs) for help, driven by a number of push and pull factors. These include socio-cultural factors, geographical proximity, and the absence or inaccessibility of overstretched and often costly allopathic healthcare services. Although traditional healers and allopathic healthcare staff share a common focus -the recovery and well-being of their patients- both systems operate largely in parallel to each other with collaborations being an exception rather than the rule. This is to the detriment of snakebite patients, who frequently find themselves being caught-up in the dualism between the two separate systems. Given the right circumstances, snakebite patients could benefit from elements of care from both modalities. Here, we have reviewed the role of THs in snakebite care and explored how their integration into the formal healthcare system could improve the implementation and outcome of care. The effective recruitment of THs to aid in disease control and treatment efforts in diseases other than snakebite underscores the potential benefits of this strategy. Carefully devised proof of concept studies are needed to test our hypothesis that collaborations between the formal healthcare sector and THs are feasible and improve outcomes in snakebite care.

Objective: The objective of this study to explore experiences of patients and carers of the pathway to diagnosis and treatment of head and neck cancer (HNC), focusing on differences based on remoteness of residence. Methods: Patients ≥6 months post‐treatment completion, and their carers, were recruited. Semi‐structured interviews, guided by the Model of Pathways to Treatment as the theoretical framework, were conducted to examine pathways to treatment of HNC and facilitators and barriers to early diagnosis and treatment. Thematic analysis with an iterative and data‐driven approach was used to identify themes. Results: A total of 39 patients and 17 carers participated in the interviews. Facilitators of timely diagnosis and treatment included a sense of urgency from health care professionals (HCPs), advocacy by the HCP or carers, and leveraging social capital. Distance to services, financial costs, and a perceived lack of emotional investment by HCPs arose as barriers to timely diagnosis and treatment. Participants were often able to rationalise that not all delays were negative, depending causes and expected impact on cancer management. Conclusion: The findings highlight the complex nature of factors facilitating and impeding early HNC diagnosis and treatment that may be targeted in interventions to support patients and meet important benchmarks for high‐quality cancer care. [ABSTRACT FROM AUTHOR]

Aim: A lack of stored iron, indicated by low serum ferritin, has been associated with various clinical symptoms. There are no longitudinal data on the frequency of ferritin measurements in children and adolescents. Methods: A total of 2834 children aged <18 years with serum ferritin and other anaemia‐related blood parameters taken during an outpatient visit between 2012 and 2019 were investigated. Patients with acute infections were excluded. Nationwide temporal and regional variations and correlations with public information searches through Google were analysed. Results: A significant increase in the frequency of ferritin measurements was seen starting in 2018, with a 47‐fold rise in 2019 compared to 2012. A simultaneous escalation in Google Search activity was seen. Deficiency of stored iron was relatively common: 21.6% of children with normal haemoglobin and 14.9% of non‐anaemic children with normal red cell indices exhibited ferritin levels below 15 μg/L. Conclusion: Ferritin measurement has increased greatly among children and adolescents. Our results suggest that public interest and popular trends can significantly influence health care practices. This calls for further investigation into the causes and consequences of such a phenomenon. Prospective randomised intervention studies are needed to evaluate the utility of iron supplementation in patients with low iron storage levels. [ABSTRACT FROM AUTHOR]

Background: The western province of Anbar, and the district of Hadeetha, have suffered direct impacts from the second United States led invasion (2003) through the ISIS invasion (2014-2017). With the primary health care centers being closed or inaccessible, the remaining population experienced changes in health seeking. The area of Anbar, Iraq remains largely remote from the discourse of health system recovery post-conflict. The objective of this study was to describe changes in health seeking behaviors of caregivers of children ages 12-72 months of age in Hadeetha, Anbar, Iraq from the conflict period of ISIS (Islamic State of Syria and Iraq), 2014-2017, to the post-conflict period, 2021., Methods: This was a mixed-methods study composed of a cross-sectional 415 household survey and focus groups in Hadeetha, Anbar, Iraq. Caretakers of children were interviewed from February to April 2021. Children were sampled from a list of children who missed at least one vaccination appointment without a return for follow-up from the birth cohorts of 2014 to 2020. Healthcare workers focus groups and key informant interviews occurred from 2019 to 2021 centered around experiences from the 2014 to 2021 period., Results: In the post-conflict period, there were no differences in health seeking based upon provider type between respondents. Physicians were primary healthcare providers in the post-conflict period for 79% of respondents versus only 47% in the conflict period. Healthcare workers described major barriers to delivering services in Hadeetha during the ISIS occupation due to infrastructure damage, threats of violence, decreased medical personnel, lack of compensation and disruptions in medical supplies from 2014 to 2017., Conclusion: This study provides insight into health seeking challenges among the many individuals who remained in Hadeetha during the ISIS occupation. Health use patterns by provider type mirror the concerns the healthcare providers shared: limited availability, efflux of professional workers, limited resources and security challenges to providing care. Positive trends toward increased access to physicians during periods of peace are an encouraging marker for continued population resilience during the post-conflict period. Recovery efforts continue to be hampered by internal sectarian discord within Iraq as well as insufficient resources to maintain health services as well as provide catch-up health services, such as immunizations., (© 2024. The Author(s).)

As the number of trans people seeking gender-affirming care (GAC) continues to increase globally, it is increasingly important to understand the experiences of this patient population to improve healthcare delivery and ensure identified needs are being met. This qualitative descriptive study describes the experiences and perspectives of trans people (age 18-34) accessing GAC in Manitoba, Canada based on data obtained from semi-structured focus groups and individual interviews ( N = 10). Three major themes were identified to capture key elements of seeking GAC: (1) the transition decision, (2) the transition process, and (3) barriers to receiving desired care. In each major theme, subthemes were described. In addition to providing insight into critical aspects of this journey, this study also highlights the importance of including a diverse variety of perspectives when considering the design of healthcare services for the trans community., Competing Interests: The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2024.)

Abstract Background Sex and gender have been shown to influence health literacy, health seeking behaviour, and health outcomes. However, research examining the links between gender and health has mainly focused on women’s health, which is a long-standing global health priority. We examine literature focused on the ‘missing men’ in global health research, in particular empirical studies that document interventions, programmes, and services targeting men’s health issues in Sub-Saharan Africa. Within these studies, we identify dominant conceptualisations of men and men’s health and how these have influenced the design of men’s health interventions and services. Methods This is a scoping review of published and grey literature. Following comprehensive searches, we included 56 studies in the review. We conducted a bibliographic analysis of all studies and used inductive methods to analyse textual excerpts referring to conceptualizations of men and service design. An existing framework to categorise services, interventions, or programs according to their gender-responsiveness was adapted and used for the latter analysis. Results From the included studies, we distinguished four principal ways in which men were conceptualized in programs and interventions: men are variously depicted as ‘gatekeepers’; ‘masculine’ men, ‘marginal’ men and as ‘clients. Additionally, we classified the gender-responsiveness of interventions, services or programmes described in the studies within the following categories: gender-neutral, −partnering, −sensitive and -transformative. Interventions described are predominantly gender-neutral or gender-partnering, with limited data available on transformative interventions. Health systems design features – focused mainly on achieving women’s access to, and uptake of services – may contribute to the latter gap leading to poor access and engagement of men with health services. Conclusion This review highlights the need for transformation in sub-Saharan African health systems towards greater consideration of men’s health issues and health-seeking patterns.

Unconditional cash transfers have demonstrated widespread, positive impacts on consumption, food security, productive activities and schooling. However, the evidence to date on cash transfers and health-seeking behaviours and morbidity is not only mixed, but the evidence base is biased towards conditional programmes from Latin America and is more limited in the context of Africa. Given contextual and programmatic design differences between the regions, more evidence from Africa is warranted. We investigate the impact of unconditional cash transfers on morbidity and health-seeking behaviour using data from experimental and quasi-experimental study designs of five government cash transfer programs in Ghana, Malawi, Zambia and Zimbabwe. Programme impacts were estimated using difference-in-differences models with longitudinal data. The results indicate positive programme impacts on health seeking when ill and on health expenditures. Our findings suggest that while unconditional cash transfers can improve health seeking when ill, morbidity impacts were mixed. More research is needed on longer-term impacts, mechanisms of impact and moderating factors. Additionally, taken together with existing evidence, our findings suggest that when summarizing the impacts of cash transfers on health, findings from conditional and unconditional programmes should be disaggregated. [ABSTRACT FROM AUTHOR]

Introduction: Health-seeking behavior is a complex outcome of many independent factors operating at individual, family, and community level. Studies have shown that there is an improvement in compliance to treatment and a decrease in the complications with an increase in patients' knowledge about the disease and its complications. The current study was done to explore the health-seeking behavior among patients diagnosed with diabetes mellitus (DM). Materials and Methods: A community-based cross-sectional descriptive study was conducted among patients diagnosed with DM in an urban area of Pondicherry. A simple random sampling method was used to recruit the study participants in the community. A predesigned structured questionnaire was used to collect information from the participants by conducting face-to-face interview. Data entry was done in EpiData and the analysis was done using the Statistical Package for the Social Sciences Version 21. Results: In the present study, 109 participants were included and interviewed. Majority of participants (29.4%) belonged to 61–70 years. Most of the respondents (56.8%) seek treatment from a private health facility. The most common comorbidity reported was hypertension (59.6%). Participants shared that unhealthy diet (55%), family history (25.7%), sedentary lifestyle (23.9%), and obesity (17.4%) were the risk factors of DM. Only 12.8% of participants were testing their blood glucose level at monthly intervals. Eight participants were on irregular medication, and among them, three participants told that they were irregular on treatment because their blood glucose levels were normal. Conclusion: The level of awareness on diabetes among the participants is not satisfactory though the overall treatment-seeking behavior is found to be satisfactory among the study participants. It is recommended to plan and implement various Information, Education and Communication (IEC) activities in the study area to increase the level awareness.

Snakebite envenomation is a neglected tropical disease and India accounts for maximum mortalities related to snakebites. This could be due to typical health seeking behaviour, inadequately trained manpower at the primary care centres or misbeliefs in community that hinder timely treatments of snakebites. The current study reports a total of 76 bites (M:F=40:36) from rural Rajasthan in Western India (Mean age= 29±17 years). The majority of victims went to health care centres e.g., primary care centres (n=44/76=57.8%), including 14 victims who reported to community health centres (18.4%). Although the majority visited health care centres (76.2%) but a total of 23/44 victims (52%) approached faith healers before going to health facilities. A sizable number took consultations from place of worship as per their faith (n=15) and snake charmers (called as bhopa in local language; n=8). Snake charmers performed the dangerous act of sucking the blood from the victim's wound (n=5).

Depression is higher among second-generation Latinas compared with immigrants, but mental health treatment is stigmatized. Therefore, second-generation Latinas were interviewed after completing an eight-session depression treatment program to gain insight on what they found valuable about their therapy experiences. Constructivist grounded theory guided data collection and analysis which showed that women valued treatment more when they recognized their needs were being met, the therapist was a worthy copilot, and the program's structure had flexibility. Four processes were considered important to their work in therapy: understanding feelings about past events, seeing patterns, accepting self, and changing family patterns but still being "family." Post therapy, women valued their enhanced confidence and a "toolbelt" of techniques they gained for self-treatment. These findings have implications for designing future depression treatment programs that are more likely to be desirable and effective for the growing subgroup of underserved second-generation Latinas in the United States.

The Enabling Universal and Equitable Access to Healthcare for Vulnerable People in Resource Poor Settings in Africa (Equitable) Project was conducted in Malawi, Namibia, South Africa, and the Sudan between 2009 and 2012. It was aimed at determining the challenges which vulnerable groups, such as persons with disabilities, experience when accessing health care. It also aimed at identifying non-users of health services at the community level and reasons why they were not accessing these services. The study found that members of the Zion Church do not seek treatment from public or private health facilities, or from traditional healers. Not much has been written about how members of the Zion Church in Malawi seek health care. This paper explores how members of the Zion Church seek health care during illness episodes. The study was conducted in four districts in Malawi. A total of twenty-five members and non-members of this church were interviewed to determine how they sought health care. The study found that members of the Zion Church do not use Western medicine: the church does not allow them to seek treatment either from Western health facilities or traditional healers, otherwise they risk excommunication. Senior members of the church pray for the sick, and patients also seek treatment from the Zion Church clinic, where prayers, blessed water, and amulets are used in the treatment of diseases. Non-members who seek treatment from the Zion Church Clinic are advised to first seek treatment from traditional healers and health facilities. The Zion Church clinic should be the last resort for these non-member patients, most of whom have been sick for a long time. After being cured, some of the non-members have been converted and joined the church. Our conclusion is that while medical pluralism exists in Malawian communities, members of the Zion Church only access treatment from their church elders and church clinics. They do not use Western medicine.

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. [ABSTRACT FROM AUTHOR]

Abstract Background Health seeking behavior is one of the challenges affecting tuberculosis (TB) control program because of its high risk to prolonged diseases transmission and poor treatment outcome. Although there are few primary studies that reported diversified magnitudes of health seeking behavior among presumptive TB patients in Ethiopia, there is no review study that attempted to summarize the available evidence. Thus, this review was aimed to estimate the proportion of health care seeking behavior from health facility and to summarize the reasons why individuals with presumptive TB are not seeking health care in Ethiopia. Method A systematic review and meta-analysis study was conducted on primary studies that reported proportion of health seeking behavior among presumptive TB patients. Electronic databases: PubMed, Google Scholar and Science Direct were searched to retrieve studies published in English language from Ethiopia without restricting publication year. In addition, bibliographies of included studies were also screened to retrieve potential studies. The keywords “health seeking”, “health seeking behavior”, “TB suspects” and “presumptive TB” were used both in Medical Subject Heading (MeSH) and free text. Random effects meta-analysis model was used to estimate the pooled proportions of health care seeking and not seeking behaviors. Stata version 14 was used for data analysis. Result Five studies which involved 3230 patients with presumptive TB were included into this review. The pooled estimated proportion of health care seeking behavior among presumptive TB patients from health facilities was 65% (95% CI, 54–76%), while the pooled proportion of not seeking health care from any sources was 17% (95% CI;6–27%). In addition, 18% (95% CI; 5–30%) of presumptive TB patients were seeking health care from inappropriate sources. Being female, younger age, low income status, absence of previous TB treatment history, low education status were the risk factors that associated with low health care seeking behavior. Conclusion Considerable proportion of patients with presumptive TB were not seeking health care from health facilities or seeks care from inappropriate sources in Ethiopia. Implementing efforts that could improve health care seeking behavior is vital to prevent prolonged disease transmission through immediate treatment commencement.

Abstract Background Mental illness is associated with misunderstanding and unfavorable attitude worldwide. The belief in its spiritual nature made traditional healers the main service consultants for mentally ill patients. The present study is a cross-sectional study conducted among 425 main family caregivers of mentally ill patients at Assiut University Hospital. The objective of the study was to assess the caregivers’ knowledge and attitude towards mental illness as well as their health-seeking behavior for their mentally ill relatives. Results The studied caregivers had low scores of knowledge and attitude towards mental illness. Age of the caregivers, their education, and the type of first consulted care and aggressive behavior of the mentally ill relatives were the significant predictors of caregivers’ knowledge and attitude towards mental illness. The majority of caregivers (80.2%) sought advice for the first time from traditional healers. Traditional healers referred only 16.4% of caregivers’ mentally ill relatives to psychiatric care. Conclusion The studied caregivers had poor knowledge and a negative attitude towards mental illness. Traditional healers were the main consulted care. So, increasing awareness of mental illness is highly recommended.

Abstract Background Available evidence on mental health and psychosocial problems in Lebanon is limited. Recent quantitative data suggests a high prevalence among Syrian refugees and their Lebanese host communities, with significant treatment gaps in both populations. This study aims to determine how Lebanese host and Syrian refugee communities perceive mental health, and identify health seeking behaviors and barriers to health access in two contrasting contexts of fragility. Methods A comparative qualitative study design was adopted whereby a total of 36 semi-structured interviews with Lebanese host and Syrian refugees’ community members were conducted, followed by a series of four participatory group model building (GMB) sessions. Participants were recruited from two contrasting fragility contexts: Beirut and Beqaa regions. During these sessions, causal loop diagrams were elicited depicting shared understandings of factors prompting the onset of mental health and psychosocial issues; health seeking behaviors, pathways and elements affecting the rate of health improvement and maintenance were also identified. Results Community members in both settings had similar perceptions of factors contributing to mental health. Participants named long-term effects of exposure to wars, political and social effects of conflicts, and financial constraints at the household level as precipitating factors prompting the onset of mental health and psychosocial stressors. Gender and integration related challenges between communities were identified as factors that affect condition onset and associated care seeking. Pathways for health seeking were found to be shaped by trust, the advice and support of loved ones, and the need to ensure confidentiality of affected individuals. Recurrent themes in discussion highlighted major barriers to healthcare access including significant delays in health care seeking from the formal health system, widespread social stigma, prohibitive service costs, lack of health coverage, limited awareness of mental health service availability and limited trust in the quality of services available. Conclusion Mental health and psychosocial support strategies need to be gender- and integration-sensitive, primarily focused on condition prevention and awareness raising in order to strengthen health-seeking behaviors.

Migration is found to have a significant impact on the socio-economic development of a region or a country. Health is deemed to be central to the social, economic and environmental dimensions of the sustainable development agenda, both as a beneficiary and a contributor. Sustainable development goals recognize the importance and interrelation between health and migration. It considers health as an indicator of ‘people-centred, rights-based, inclusive, and equitable development' (U.N., 2015). The review has aimed at understanding the perceived morbidity and health-seeking behaviour among women migrant workers. This paper encapsulates the relation between climate change and health on women migrants. It is thereby helping to understand the potential health issues faced by female migrant workers as a result of climate change along with addressing their challenges and barrier faced by the female migrants in availing health services. The paper suggests the needed changes to be adopted to help provide better health care facilities for the women migrant workers, thereby being able to reduce the threat of outbreak as well as to improve the public health. The study has both research and policy implications.

Background: Guardians' involvement in the management of childhood illnesses plays a pivotal role in reducing mortality and morbidity among children under 5 years old. It is through the guardian's eyes that the child can be afforded timely healthcare, prevented from contracting an illness and effectively taken prescribed medication., Aim: The study aimed to explore the guardians' lived experiences in their involvement in managing childhood illnesses in Vhembe district, Limpopo province, South Africa., Setting: A qualitative, exploratory and descriptive study was conducted with 16 purposively sampled participants., Methods: One-on-one individual interviews were conducted with participants. Data were analysed following Braun and Clarke's thematic analysis., Results: Guardians reported their involvement by seeking child healthcare in healthcare facilities when ill and due for immunisations. Involvement in childhood care is performed through assessment of child illness at home, follow-up, referral of children to healthcare facilities, promotion of child health and prevention of childhood illnesses., Conclusion: Children remain dependent on guardians for their well-being. Seeking care, preventing illnesses and promoting childhood health are vital in reducing child mortality and childhood morbidity., Contribution: Involving and empowering guardians regarding the care of children under 5 years old are vital in achieving Sustainable Development Goal number 3 in 2030., Competing Interests: The authors declare that they have no financial or personal relationships that may have inappropriately influenced them in writing this article., (© 2024. The Authors.)

Readmissions and emergency department (ED) visits after colorectal surgery (CRS) are common, burdensome, and costly. Effective strategies to reduce these unplanned postdischarge health care visits require a nuanced understanding of how and why patients make the decision to seek care. We used a purposefully stratified sample of 18 interview participants from a prospective cohort of adult CRS patients. Thirteen (72%) participants had an unplanned postdischarge health care visit. Participant decision-making was classified by methodology (algorithmic, guided, or impulsive), preexisting rationale, and emotional response to perceived health care needs. Participants voiced clear mental algorithms about when to visit an ED. In addition, participants identified facilitators and barriers to optimal health care use. They also identified tangible targets for health care utilization reduction efforts, such as improved care coordination with streamlined discharge instructions and improved communication with the surgical team. Efforts should be directed at improving postdischarge communication and care coordination to reduce CRS patients' high-resource health care utilization. [ABSTRACT FROM AUTHOR]

Sickle cell disease (SCD) is a chronic genetic disease that causes life-threatening complications and requires robust comprehensive management. Developing comprehensive SCD programs in sub-Saharan African countries requires knowledge of the cultural factors affecting health-seeking behavior. We utilized an ethnographic approach and the frameworks of Dutta and Habermas to explore cultural factors influencing SCD management in rural Sierra Leone. A purposive sample of 27 individuals with SCD and their family and professional caregivers were observed and interviewed from March 2019 to April 2019. We identified four domains (Cultural Beliefs, Cultural Values, Cultural Practices, and Dealing with SCD) of cultural influences on SCD management, and 12 sub-themes (related to collectivism; spiritual, traditional, and Western beliefs and practices; and lived experiences) that reflect the personal, social, structural, and contextual complexities of SCD management. Further research regarding roles of traditional and spiritual leaders, combinations of Western and traditional practices, and culturally centered interventions is warranted. [ABSTRACT FROM AUTHOR]

Students with disabilities are one student group with elevated risk of sexual violence. Although they would benefit from streamlined access to campus support, little is known about their patterns of campus service use. This qualitative analysis includes data from semi-structured interviews with 51 students with disabilities who experienced sexual violence focused on service use across campus. The resultant conceptual model shows that greater accessibility is associated with positive experiences, and lower accessibility is associated with negative experiences. Students with disabilities who experienced or expected negative reactions (e.g., judgment) were less likely to use services and were less satisfied. Advocacy and support in connecting students with disability or sexual violence services was associated with positive experiences and increased accessibility. These findings highlight key facilitators and barriers to campus service use for students with disabilities with sexual violence histories and suggest key intervention points for increasing accessibility, reducing stigma, and improving student experiences with campus providers, staff, and faculty. [ABSTRACT FROM AUTHOR]

Abstract Background Adolescents are especially vulnerable due to increased biological, social and economic risks associated with early pregnancy and childbirth, yet most pregnancy and childbirth-related complications are preventable through a combination of proven, cost-effective clinical interventions including timely antenatal care (ANC). The voices and specific needs of adolescents are currently underrepresented in the literature on antenatal and maternity care. Objectives were to a) increase our understanding of adolescents’ experiences with, and perceptions of, ANC and b) explore how these perspectives might be applied towards future initiatives to enhance adolescent care-seeking behaviour. Methods This cross-sectional qualitative study employed 14 focus group discussions with 112 adolescents aged 15–20 years in Singida Region in Tanzania and Volta and Eastern Regions in Ghana who had accessed ANC during their most recent pregnancy. We were particularly interested in what these young women valued and understood about their ANC experience, as this would provide insights into what factors motivated them to seek care. Transcripts were analyzed using conventional content analysis. Based on emergent themes and drawing on the Health Belief Model (HBM) as an analytical tool, a conceptual framework was developed to illustrate the myriad factors influencing adolescents’ decision to attend ANC. Results Interpreting results through an adapted HBM demonstrates that adolescent health-seeking behaviour can vary widely among individuals and within communities, is shaped by the opinions of family members and peers, and is intrinsically influenced by broader health systems-level factors. Conclusions The results led to our development of an adapted theory-based framework to illustrate the complexity of adolescent care-seeking during pregnancy in resource-poor settings. We demonstrate that while an adolescent mother is capable of exercising her own agency, she is also developmentally vulnerable to external influences and must be supported in her ability to make autonomous decisions. While the model presented here focuses specifically on ANC utilization, it may have applications for understanding how adolescents engage with health services more broadly.

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 3.6 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.

Background: Population aging is inevitable. Old age is marked with health problems because of aging process, long-term chronic illnesses, also associated with social and mental problems. Objectives: To determine the pattern of physical morbidities in geriatric population and to study the utilization of health services among them. Methods: A cross-sectional study was undertaken from April to September 2017, among 270 consenting elderly people, residing in urban slums under field practice area of a medical college, using a structured interview schedule. Results: Among the 270 elderly, 36.30% were males, 80% belonged to nuclear families. A total of 262 reported of some morbidity, 61.85% had hypertension, 45.19% had diabetes, 37.78% had acid peptic disease, and 51.08% reported to have 1--3 morbidities. Majority (41.85%) of them had visited a physician on an average of 4--6 times in the preceding year. A total of 84.81% went to the urban health center, whereas 24.81% to a government hospital for treatment. Reasons cited for preference of health facility were “free consultation” and “nearby location” (85.19%). A total of 90.74% received allopathic medicines. Conclusion: Prevalence of morbidity was found to be high, which can be attributed to their compromised living conditions. Health-seeking behavior was found to be good.

Background: Depression is the most common complication postpartum affecting 10%–15% of women, contributing greatly to maternal mortality and morbidity, but the care availed is very low among the women who suffer. Objective: The aim is to study the prevalence of postpartum depression among recently delivered women in a rural population and the health care utilization pattern for the condition among women. Methodology: This was conducted as a population-based cross-sectional study in a rural population served by primary health center. All women in the study area who had a pregnancy outcome during the past 6 months and have completed 42 days since their last delivery were included in the study. The data on postpartum depression were collected using the Edinburgh Postnatal Depression Scale (EPDS). Results: There were 365 postpartum women in the study area who participated in the study. Mean age of the study participants was 24.5 years. The deliveries were Institutional in 97.8% of women. The prevalence of depression among the study women (an EPDS score of 10 and above) was 11%. Among women with depression, a history of depression before the last delivery was given by 42.5% of women. Only 7.5% of women had sought some form of health care for their problem. Conclusion: The study shows that the prevalence of depression among postpartum women is quite high and the health seeking for depression is very low. Health professionals and workers have to be trained to raise awareness, detect, and treat depression among postpartum women promptly.

Background: Asthma is the third most common cause of hospital visits in Sudan. Sudan has a pluralistic health care system, with a strong and varied private sector. While research examining public sector asthma services exists, very little is known about which asthma services are available in the private sector. Methods: An explanatory sequential mixed-method social ecological approach was used to examine influencing factors of asthma service utilisation in the private sector, considering five levels: policy, organisational, community, familial, individual environment. Quantitative research involved surveying private healthcare facilities to describe asthma services. Qualitative research involved in-depth interviews with asthma patients to explore facility decision-making. Nine private chest clinics, 44 pharmacies, and 21 private hospitals offering asthma services in Khartoum were studied - 46 female and 28 male health providers were surveyed; 7 male and 7 female asthma patients were interviewed. Results: At the health policy level, there is no current asthma management policy for the private sector. At the organisational and health systems level, the survey found low rates of diagnostic equipment available, little asthma-specific training, and little use of asthma treatment cards, guidelines, and registers. At the community level, high levels of stigma from the community were felt by most of the patients interviewed. At the familial level, asthma was often viewed as a hereditary condition, and, as a long-term condition, there were worries about marriage potential and impact on jobs/future activities. At the individual level, patients sought frequent, short-term care at private facilities for acute attacks. The severity of the disease and the major impact it had, particularly on younger adults’, was striking. Conclusions: Applying an ecological framework to examine asthma care management enables review of all levels of service provision: inclusive health policy, government commitment, high quality service delivery, uninterrupted affordable drug supply, community involvement, and patient empowerment.

Background: Sex and gender have been shown to influence health literacy, health seeking behaviour, and health outcomes. However, research examining the links between gender and health has mainly focused on women's health, which is a long-standing global health priority. We examine literature focused on the 'missing men' in global health research, in particular empirical studies that document interventions, programmes, and services targeting men's health issues in Sub-Saharan Africa. Within these studies, we identify dominant conceptualisations of men and men's health and how these have influenced the design of men's health interventions and services. Methods: This is a scoping review of published and grey literature. Following comprehensive searches, we included 56 studies in the review. We conducted a bibliographic analysis of all studies and used inductive methods to analyse textual excerpts referring to conceptualizations of men and service design. An existing framework to categorise services, interventions, or programs according to their gender-responsiveness was adapted and used for the latter analysis. Results: From the included studies, we distinguished four principal ways in which men were conceptualized in programs and interventions: men are variously depicted as 'gatekeepers'; 'masculine' men, 'marginal' men and as 'clients. Additionally, we classified the gender-responsiveness of interventions, services or programmes described in the studies within the following categories: gender-neutral, −partnering, −sensitive and -transformative. Interventions described are predominantly gender-neutral or gender-partnering, with limited data available on transformative interventions. Health systems design features – focused mainly on achieving women's access to, and uptake of services – may contribute to the latter gap leading to poor access and engagement of men with health services. Conclusion: This review highlights the need for transformation in sub-Saharan African health systems towards greater consideration of men's health issues and health-seeking patterns. [ABSTRACT FROM AUTHOR]

Background: Asthma is the third most common cause of hospital visits in Sudan. Sudan has a pluralistic health care system, with a strong and varied private sector. While research examining public sector asthma services exists, very little is known about which asthma services are available in the private sector. Methods: An explanatory sequential mixed-method social ecological approach was used to examine influencing factors of asthma service utilisation in the private sector, considering five levels: policy, organisational, community, familial, individual environment. Quantitative research involved surveying private healthcare facilities to describe asthma services. Qualitative research involved in-depth interviews with asthma patients to explore facility decision-making. Nine private chest clinics, 44 pharmacies, and 21 private hospitals offering asthma services in Khartoum were studied - 46 female and 28 male health providers were surveyed; 7 male and 7 female asthma patients were interviewed. Results: At the health policy level, there is no current asthma management policy for the private sector. At the organisational and health systems level, the survey found low rates of diagnostic equipment available, little asthma-specific training, and little use of asthma treatment cards, guidelines, and registers. At the community level, high levels of stigma from the community were felt by most of the patients interviewed. At the familial level, asthma was often viewed as a hereditary condition, and, as a long-term condition, there were worries about marriage potential and impact on jobs/future activities. At the individual level, patients sought frequent, short-term care at private facilities for acute attacks. The severity of the disease and the major impact it had, particularly on younger adults’, was striking. Conclusions: Applying an ecological framework to examine asthma care management enables review of all levels of service provision: inclusive health policy, government commitment, high quality service delivery, uninterrupted affordable drug supply, community involvement, and patient empowerment.

Introduction: Health-seeking behavior is a complex outcome of many independent factors operating at individual, family, and community level. Studies have shown that there is an improvement in compliance to treatment and a decrease in the complications with an increase in patients' knowledge about the disease and its complications. The current study was done to explore the health-seeking behavior among patients diagnosed with diabetes mellitus (DM). Materials and Methods: A community-based cross-sectional descriptive study was conducted among patients diagnosed with DM in an urban area of Pondicherry. A simple random sampling method was used to recruit the study participants in the community. A predesigned structured questionnaire was used to collect information from the participants by conducting face-to-face interview. Data entry was done in EpiData and the analysis was done using the Statistical Package for the Social Sciences Version 21. Results: In the present study, 109 participants were included and interviewed. Majority of participants (29.4%) belonged to 61--70 years. Most of the respondents (56.8%) seek treatment from a private health facility. The most common comorbidity reported was hypertension (59.6%). Participants shared that unhealthy diet (55%), family history (25.7%), sedentary lifestyle (23.9%), and obesity (17.4%) were the risk factors of DM. Only 12.8% of participants were testing their blood glucose level at monthly intervals. Eight participants were on irregular medication, and among them, three participants told that they were irregular on treatment because their blood glucose levels were normal. Conclusion: The level of awareness on diabetes among the participants is not satisfactory though the overall treatment-seeking behavior is found to be satisfactory among the study participants. It is recommended to plan and implement various Information, Education and Communication (IEC) activities in the study area to increase the level awareness. [ABSTRACT FROM AUTHOR]