Care Seeking for Neonatal Illness in Low- and Middle-Income Countries: A Systematic Review

Hadley Herbert and colleagues systematically review newborn care-seeking behaviors by caregivers in low- and middle-income countries

Improving care-seeking for facility-based health services in a rural, resource-limited setting: Effects and potential of an mHealth project

The aim of this paper was to investigate the impact of a toll-free hotline and mobile messaging service on care-seeking behaviors. Due to the low uptake of the services, the treatment on the treated estimate is used. For maternal health, the intervention had a strong, positive impact on antenatal care initiation and skilled birth attendance. No effect was observed for postnatal check-ups, receiving the recommended four antenatal care visits and vitamin A uptake. A negative effect was observed on tetanus toxoid coverage. For child health, no change was seen in child immunization, and a significant decrease was observed for care-seeking for children with fever. Different factors are associated with care-seeking, which may explain in part the variations seen across care-seeking behaviors and possible influence of exogenous factors. Introduction of mHealth services for demand generation require attention to local health systems to ensure adequate supply and quality are available

Caregiver Recognition of Childhood Diarrhea, Care Seeking Behaviors and Home Treatment Practices in Rural Burkina Faso: A Cross-Sectional Survey

Introduction: To design effective national diarrhea control programs, including oral rehydration solution (ORS) and therapeutic zinc supplementation, information is needed on local perceptions of illness, external care seeking behaviors, and home treatment practices. Methods: A cross-sectional, community-based household survey was conducted in the Orodara Health District, Burkina Faso. Caregivers of 10,490 children,27 months were interviewed to assess child diarrhea prevalence and related car

Gender difference in knowledge of tuberculosis and associated health-care seeking behaviors: a cross-sectional study in a rural area of China

<p>Abstract</p> <p>Background</p> <p>Tuberculosis (TB) detection under the national TB control program in China follows passive case-finding guidelines, which could be influenced by the accessibility of health service and patient's health-care seeking behaviors. One intriguing topic is the correlation between men and women's knowledge on TB and their health-care seeking behaviors.</p> <p>Methods</p> <p>Two cross-sectional studies were separately carried out in Yangzhong County, a rural area of China. One study, by using systematic sampling method, including 1,200 subjects, was conducted to investigate the TB knowledge among general population. Another study in the same source population screened 33,549 people aged 15 years or over among 20 stratified cluster-sampled villages for identifying prolonged cough patients at households and individual interviews were then carried out. Gender difference in the knowledge of TB and health-care seeking behaviors was analyzed particularly.</p> <p>Results</p> <p>Among general population, only 16.0% (men 17.1% vs. women 15.0%) knew the prolonged cough with the duration of 3 weeks or longer was a symptom for suspicious TB. Fewer women than men knew the local appointed health facility for TB diagnosis and treatment as well as the current free TB service policy. Moreover, women were less likely to learn information about TB and share it with others on their own initiatives. On the contrary, after the onset of the prolonged cough, women (79.2%) were more likely to seek health-care than men (58.6%) did. However, a large part of women preferred to visit the lower level non-hospital health facilities at first such as village clinics and drugstores.</p> <p>Conclusion</p> <p>TB and DOTS program were not well known by rural Chinese. Gender issues should be considered to reduce diagnostic delay of TB and improve both men and women's access to qualified health facility for TB care. Strengthening awareness of TB and improving the accessibility of health-care service is essential in TB control strategy, especially under the current vertical TB control system.</p

Healthcare Seeking Behaviors of Sexually Assaulted Women

Background: Sexual assault is a crime that leaves long term psychological and physical effects on survivors, including panic attacks, trust issues, somatic body pain, and poor overall health. Seeking out health services is important in treating these lasting effects. However, research is lacking into the health care seeking behaviors of sexually assaulted women and whether or not the sexual assault plays a role into their habits. Objective: The purpose of this study was to explore the long-term effect that sexual assault has on the health care seeking behavior of female survivors. Methods: An integrative literature review was conducted that included recent primary peer reviewed sources. Results: Many factors were discovered to affect the health care seeking habits including fear of the health care provider reaction to disclosure and fear of medical procedures. Sexual assault survivors also expressed more dissatisfaction with health care services than non-assaulted women. Interventions to improve the satisfaction of survivors include provided guidelines to trauma informed care, appropriate responses to disclosure, “inform before perform” care and explanations and reassurance during procedures. Conclusion: Sexual assault is a crime that leads to long term effects on the survivor. There is a relationship between the sexual assault and future health care seeking behaviors of survivors both during the initial aftermath and in future encounters with HCPs. Interventions by HCPs, including nurses, can ensure better more appropriate care for survivors

Individual and structural factors influencing HIV care linkage and engagement: Perceived barriers and solutions among HIV-positive persons

To meet the National HIV/AIDS Strategy’s goals of reducing and preventing HIV transmission, understanding factors that shape HIV-positive persons’ care-seeking behaviors is critical. Accordingly, this study examined factors that affect HIV care linkage and engagement. Six focus groups were conducted with 33 HIV-positive persons living in North Carolina. A variety of factors influenced care behaviors, including: structural and policy factors, relationship with HIV care systems, and individuals’ personal characteristics. Participants also provided solutions for addressing specific factors to care. Improving clinical services and utilizing context-specific strategies can help facilitate greater care linkage and engagement

Changing poor mothers' care-seeking behaviors in response to childhood illness: findings from a cross-sectional study in Granada, Nicaragua

BACKGROUND: In 2008, approximately 8.8 million children under 5 years of age died worldwide. Most of these deaths occurred in developing countries, but little is known about poor mothers' care-seeking behaviors for their children. We examined poor mothers' care-seeking behaviors in response to childhood illness, and identified factors affecting their choices. We also assessed mothers' perception of the medical services and their confidence in the health care available for their children. METHODS: We carried out a community-based cross-sectional study with structured questionnaires. Participants were 756 mothers and their young children (0-23 months) in Nandaime municipality, Granada province, Nicaragua. We took the children's anthropometric measurements and we assessed the mothers according to their income. We divided them into 3 global absolute poverty categories (income: <1 USD/day, 1-2 USD/day, >2 USD/day), and 4 quintile. RESULTS: When a child showed symptoms of illness, most mothers (>75%) selected public health facilities as their first choice. More than half (>58%) were satisfied with the medical services, but the poorest mothers expressed more dissatisfaction (p = 0.003), when we divided the participants into 4 quintiles groups according to their income. In the poorest group, the main reasons for dissatisfaction were cost (46.6%), and distance to the facilities (25.8%). Almost half (41.3%) of mothers lacked confidence in the health care offered to their child, while most of the wealthiest mothers (75.7%) did have confidence in it (p = 0.001). The poorest mothers showed greater interest in health education than the wealthiest (86.2% vs. 77.8%) (p = 0.015). We found that poor mothers (≤2 USD/day) changed their second choice for care in a positive direction. Factors affecting the change in second choice were the child having symptoms of respiratory disease (AOR, 2.51; 95% CI, 1.28-4.90, p = 0.007), visiting health post as the first choice (AOR, 2.11; 95% CI, 1.26-3.53, p = 0.005), and experiencing a child death in the past (AOR, 2.05; 95% CI, 1.15-3.68, p = 0.016). Child stunting, mother's level of education, and past participation in health education programs did not affect. CONCLUSIONS: Determination of the severity of a childhood disease is a difficult task for mothers. The national rural health system was functioning, yet the services were often limited. We should consider the feasibility of providing a more effective primary care system for the poor. To encourage mothers' care-seeking behaviors in poor settings, the referral system and the social safety net need to be strengthened. Poor mothers need further education about the danger signs of childhood illness

Determinants of health care seeking behaviors in puerperal sepsis in rural Sindh, Pakistan: A qualitative study

Background: Puerperal sepsis (PS) is one of the major causes of maternal death, contributing to 26,000 deaths per year in developing countries. Early recognition and treatment are essential to managing PS, but numerous social, cultural and technical barriers prevent or delay access to care and necessary medical attention. Through this qualitative study, we identified barriers to care seeking for puerperal sepsis among recently delivered women in Matiari, Pakistan. Methods: We conducted 20 in-depth interviews among recently delivered women with and without sepsis and their family members in September 2012. Key informant interviews were conducted with 14 healthcare providers and traditional birth attendants. The themes used for content analysis were knowledge of danger signs, factors affecting care seeking and local treatment practices for postpartum sepsis. Results: A total of 34 interviews were conducted. Recently delivered women, their family members and traditional birth attendants were unaware of the word PS or the local translated term for PS. However, they were familiar with most of the individual symptoms associated with PS. Healthcare providers were aware of the condition and the associated symptoms. The healthcare providers’ understanding of the seriousness of PS was directly proportional their age and clinical experience. The most common barriers to care seeking was the division of labor within the household, obtaining permission from the primary decision maker, access to transportation, lack of financial resources and support from family members.Conclusion: To improve maternal care seeking behaviors for PS, interventions focusing on increasing knowledge of PS, addressing gender inequality, implementing an affordable community transport service and enhancing TBA’s knowledge and skills to manage PS need to be implemented

More Evidence on the Impact of India's Conditional Cash Transfer Program, Janani Suraksha Yojana: Quasi-Experimental Evaluation of the Effects on Childhood Immunization and Other Reproductive and Child Health Outcomes

Background: In 2005, India established a conditional cash transfer program called Janani Suraksha Yojana (JSY), to increase institutional delivery and encourage the use of reproductive and child health-related services. Objective: To assess the effect of maternal receipt of financial assistance from JSY on childhood immunizations, post-partum care, breastfeeding practices, and care-seeking behaviors. Methods: We use data from the latest district-level household survey (2007–2008) to conduct a propensity score matching analysis with logistic regression. We conduct the analyses at the national level as well as separately across groups of states classified as high-focus and non-high-focus. We carry out several sensitivity analyses including a subgroup analysis stratified by possession of an immunization card. Results: Receipt of financial assistance from JSY led to an increase in immunization rates ranging from 3.1 (95%CI 2.2–4.0) percentage points for one dose of polio vaccine to 9.1 (95%CI 7.5–10.7) percentage points in the proportion of fully vaccinated children. Our findings also indicate JSY led to increased post-partum check-up rates and healthy early breastfeeding practices around the time of childbirth. No effect of JSY was found on exclusive breastfeeding practices and care-seeking behaviors. Effect sizes were consistently larger in states identified as being a key focus for the program. In an analysis stratified by possession of an immunization card, there was little to no effect of JSY among those with vaccination cards, while the effect size was much larger than the base case results for those missing vaccination cards, across nearly all immunization outcomes. Conclusions: Early results suggest the JSY program led to a significant increase in childhood immunization rates and some healthy reproductive health behaviors, but the structuring of financial incentives to pregnant women and health workers warrants further review. Causal interpretation of our results relies on the assumption that propensity scores balance unobservable characteristics