Delay In Seeking Health Care Research Articles

Predictors of delayed health seeking for febrile children: multi-level analysis of cross-sectional study data from southern Ethiopia.

Febrile illnesses are commonly reported as a primary reason for seeking healthcare in sub-Saharan Africa. Timely diagnosis and getting prompt treatment within 24 h of fever onset is crucial to avert the risk of developing severe complications and death. Understanding factors contributing to delayed health seeking is important for public health interventions. Hence, this study aimed to assess individual- and contextual-level factors associated with the delay in seeking prompt treatment for children with fever. A community-based cross-sectional study was conducted from September 2022 to June 2023 in Gamo zone, southern Ethiopia. Three districts were chosen, and then, from each district, six clusters or kebeles were chosen by simple random sampling. A total of 820 caregivers were randomly selected. A two-level mixed-effects logistic regression model was employed to identify factors associated with the delay in seeking prompt treatment. The associations were measured by an adjusted odds ratio (AOR), and statistical significance was declared at a 5% level of significance. The prevalence of the delay in seeking prompt care was 47.8%. Factors contributing to the delay were caregivers who were aged 30 years and above [AOR 0.23, 95% confidence interval (CI): 0.10-0.52], caregivers who followed the Protestant religion (AOR 3.67, 95% CI: 2.08-6.48), caregivers unable to read and write (AOR 5.32, 95% CI: 6.80-11.70), merchant caregivers (AOR 6.63, 95% CI: 2.75-15.97), caregivers who were exposed to only one media source (AOR 9.3, 95% CI: 8.43-15.60), caregivers with the experience of child death (AOR 0.05, 95% CI: 0.01-0.22), and caregivers seeking permission from their partners to access healthcare (AOR 12.64, 95% CI: 6.98-22.89). There was a high level of delay in seeking healthcare. Targeted community education through mass media, healthcare facilities, and community-level awareness campaigns should be strengthened to improve early treatment seeking and lessen the consequences of delayed treatment seeking.

Delay in healthcare seeking and associated factors among patients presenting with sexually transmitted infection symptoms in the Horo Guduru Wollega Zone, Oromia, Western Ethiopia, 2022.

Sexually transmitted infections (STIs) are the most prevalent communicable diseases that impact people's health and wellbeing. One of the main obstacles to successful prevention and control of STIs is the delay in seeking healthcare, which can result in significant personal and economic losses. However, there are limited studies on the delay in healthcare seeking among STI patients in resource-limited countries such as Ethiopia. This study aims to assess delays in seeking healthcare and associated factors among patients presenting with STIs at public health facilities in the Horo Guduru Wollega Zone, Oromia, Western Ethiopia, 2022. A cross-sectional study was conducted at public health facilities in the Horo Guduru Wollega Zone from 15 March to 15 May 2022. The study included 507 participants and used a consecutive sampling method. The outcome variable of the study was the delay in seeking healthcare among STI patients. A binary logistic regression model was used to identify candidate variables with a p-value of less than 0.25 after analyzing each variable separately. Finally, a multivariable analysis was performed to determine statistically significant variables at a p-value of less than 0.05, and an adjusted odds ratio (AOR) was reported. The proportion of individuals with STIs who delayed seeking healthcare in the Horo Guduru Wollega Zone was 61.3% [95% confidence interval (CI): 57%-65.5%]. Factors such as age >35 years (AOR = 2.23, 95% CI: 1.26-3.95), higher educational level (AOR = 2.72, 95% CI: 1.55-4.74), lack of condom use (AOR = 1.63, 95% CI: 1.05-2.55), and travel time to health facilities of >1 h (AOR = 4.30, 95% CI: 1.70-10.89) were found to be significantly associated with delayed healthcare seeking. This study found that the magnitude of delay in seeking healthcare was higher than the national average and identified several contributing factors. Interventions such as developing educational programs and improving access to healthcare services are crucial for supporting patients with STIs. Enhancing healthcare accessibility in rural areas and promoting the use of condoms through targeted community outreach can reduce travel time and prevent delays in seeking healthcare for STIs.

Occupation and demand for health services in Italy: Ways and means to reduce the opportunity costs imposed on patients

This paper explores whether and to which extent employment condition and working hours influence individuals’ decision process in consuming primary care. The hypothesis is that the higher the workers’ opportunity cost in terms of earning forgone, the less the demand for General Practitioner (GP) visits. Using survey data provided by the Italian National Institute of Statistics (ISTAT), we estimate a negative binomial regression model of GP visits as a function of employment related variables, controlling for a rich set of individual demographic characteristics, socio-economic variables, health status, supply and geographical factors. We show that self-employed workers, managers and cadres use significantly less primary care services notwithstanding the access is free. We conclude that they have higher opportunity costs than white and blue collars since they suffer more from the loss of earnings related to the absence from work. Self-employed individuals often face barriers to accessing healthcare services, such as lack of employer-sponsored health insurance and concerns about lost income during time off for medical appointments. As a result, they may delay seeking healthcare until their condition becomes more severe, leading to poorer health outcomes. Managers and cadres, on the other hand, may have greater access to healthcare services due to higher income levels and better job benefits. However, they may still face challenges such as long working hours and job-related stress, which can impact their ability to prioritize their health and seek timely medical care.From a policy perspective, our results suggest potential policy interventions aimed at addressing barriers to healthcare access for self-employed workers and promoting equitable healthcare utilization across different employment groups. Policy recommendations may include measures to enhance financial support (tax deductions for medical expenses, subsidies for health insurance premiums, or grants to cover the costs of healthcare-related absences from work), increase healthcare accessibility (enhancing the availability of mobile clinics, and extending operating hours for primary care facilities to accommodate the needs of working individuals) and raise awareness about preventive care among self-employed workers (workplace wellness programs, and incentives for regular health check-ups, screenings and healthy lifestyle choices, can encourage managers and self-employed workers to prioritize preventive measures). These policy implications are essential for ensuring equitable and universal access to healthcare services for all workers, regardless of their employment status.

IJCM_15A: Health-seeking behaviour among Fishermen community mothers of under-five children on childcare– A cross-sectional study

Background: Globally in 2020 an estimated 5 million children under5 years died mostly from preventable and treatable causes. India ranks second worldwide in under5 mortality (WHO2020). Health of the children is strongly dependent on parental healthcare behaviour Fishermen-community possesses unique characteristics of a folk-society, Major portion of the life of fishermen is spent at sea, mothers assume a vital place with regard to the upbringing of the children. Objective: To study the health-seeking behaviour among Fishermen- community mothers of under-five children during acute illness and factors associated with it Methodology: A cross sectional study was conducted among 100 Mothers of Under five children in a Fishermen community, Kovalam, Chengalpattu district of Tamil Nadu over a period of 3months (October 2023–November 2023). Data collection was done using interviewer administered semi-structured questionnaire, statistical analysis was done using SPSS v21.0 Results: In total, 100 mothers with mean age of 27± 3.3 years participated in the study, all of them reported of some health morbidity. The proportion of health seeking behaviour in terms of appropriate and prompt care among the study population was 42%. The reason for delayed health care seeking among the participants were due to over-the-counter drugs(33%), self-medication(17%) and home remedies(8%). Among them 84% sought health care from private health facility. Appropriate and prompt care has found to be significantly associated with the age of the child less than 2 years (OR-3.485,95%CI-1.449-8.382), educational status of the mother (above high-school) (OR-3,95%CI-1.328-6.977), extended family type (OR- 2.679,95%CI-1.151-6.233) and perception about severity of illness during an episode of acute illness. Conclusion: Appropriate Health-seeking behaviour and seeking prompt care among parents of children was inadequate. Utilization of public health facility was less. Hence, steps can be taken to sensitize the mothers about the services available in the public health care facility.

Healthcare seeking behavior and delays in case of Drug-Resistant Tuberculosis patients in Bangladesh: Findings from a cross-sectional survey.

The emergence of Drug-Resistant Tuberculosis (DR-TB) has become a major threat globally and Bangladesh is no exception. Delays in healthcare seeking, proper diagnosis and initiation of treatment cause continuous transmission of the resistant tubercule bacilli through the communities. This study aimed to assess the different health care-seeking behaviors and delays among DR-TB patients in Bangladesh. A prospective cross-sectional study was conducted from November to December 2018, among 92 culture positive and registered DR-TB patients in four selected hospitals in Bangladesh. Data were collected through face-to-face interviews with survey questionnaire as well as record reviews. Among the 92 study participants, the median patient delay was 7 (IQR 3, 15) days, the median diagnostic delay was 88 (IQR 36.5, 210), the median treatment delay was 7 (IQR 4,12) days, and the median total delay among DR-TB patients was 108.5 (IQR 57.5, 238) days. 81.32% sought initial care from informal healthcare providers. The majority (68.48%) of the informal healthcare providers were drug sellers while 60.87% of patients sought care from more than four healthcare points before being diagnosed with DR-TB. The initial care seeking from multiple providers was associated with diagnostic and total delays. In Bangladesh, DR-TB cases usually seek care from multiple providers, particularly from informal providers, and among them, alarmingly higher healthcare-seeking related delays were noted. Immediate measures should be taken both at the health system levels and, in the community, to curb transmission and reduce the burden of the disease.

Delayed healthcare seeking and associated factors for common childhood illnesses among caregivers with under-five children who visited Yem special woreda public health facilities, Southwest Ethiopia, 2023.

For under-five children, receiving timely and appropriate medical attention is crucial in preventing serious and fatal complications. Unfortunately, evidence shows that parents of young children frequently delay seeking care, contributing to the death of many kids before they even get to a medical facility. The study aimed to assess delay in healthcare seeking and associated factors for common childhood illnesses among caregivers with under-five children visiting Yem special woreda public health facilities, 2023. A facility-based cross-sectional study was conducted among 333 caregivers of under-five children diagnosed with common childhood illnesses visiting Yem special woreda public health facilities. Systematic random sampling was employed, and data was collected using an interviewer-administered questionnaire. Delay was characterized as a long time (typically >24 hours) between disease onset and beginning of treatment. Data was entered into Epi Data version 4.7 and exported to Statistical Package for the Social Sciences version 25.0. Binary logistic regression model was fitted. Bi-variable and multivariable logistic regression analyses were conducted to identify the factors that influence the delayed healthcare seeking. Adjusted odds ratios with a 95% confidence interval were used to determine the associations. Statistically significant variables were identified based on a p-value < 0.05. A total of 326 caregivers participated in the study with a response rate of 98%. The proportion of delayed health care seeking was 74.5%. Caregivers "wait-and-see" approach is the primary reason for the delay followed by traditional home treatments. Child ≥ 12 months (AOR = 1.99, 95% CI: 1.11-3.57), rural residence (AOR = 2.41, 95% CI: 1.35-4.28), no community health insurance (AOR = 1.91, 95% CI: 1.07-3.42), traditional treatment (AOR = 2.98, 95% CI: 1.46-6.10), and initial self-medication at home (AOR = 2.73, 95% CI: 1.32-5.63) and perceiving illness as mild (AOR = 2.64, 95% CI: 1.28-5.42) were factors associated with delayed healthcare seeking. The study showed delay in health care seeking for common childhood illnesses among caregivers was high. Hence, reducing delays necessitates the implementation of public education campaigns, collaboration with local organizations, and the provision of counseling for caregivers regarding childhood illnesses.

Healthcare-Seeking Delays in Acute Ischemic Stroke Patients: The Influence of Gender, Immigrant Status, and Educational Background.

Timely medical attention is crucial for patients with Acute Ischemic Stroke (AIS), as delays can significantly impact therapeutic outcomes. These delays are influenced by a combination of socio-cultural, educational, and clinical factors. An in-depth analysis was conducted to assess the prevalence and median duration of healthcare-seeking delays in AIS patients. The study specifically investigated the independent impacts of sociocultural and clinical determinants on these delays, with a focus on immigrant status, gender disparities, and educational levels. Multivariate regression analysis was employed to identify these independent effects while controlling for potential confounding factors. Among 1419 AIS patients, 82.52% (n = 1171) experienced delays exceeding 2 hours from symptom onset of symptoms to hospital arrival. The median delay was 12.3 hours. Immigrant populations encountering longer delays compared to native groups. Younger males (<45 years) and elderly females were more prone to delay in healthcare-seeking. Identified independent risk factors for delay included male gender (OR = 1.65 [95% CI:1.14-2.48]), self-acknowledged diabetes (OR = 2.50 [95% CI:1.21-5.17]), small vessel (OR = 2.07 [95% CI:1.27-3.36]), and wake stroke (OR = 7.04 [95% CI:3.69-13.44]). Educational background (high school and above), GCS score with 3-8 points (OR = 0.52 [95% CI:0.09-0.69]), understanding stroke-related knowledge (OR = 0.26 [95% CI:0.09-0.44]), conscious disturbance (OR = 0.25 [95% CI:0.10-0.62]) and limb weakness (OR=0.21[95% CI:0.21-0.49]) are protective factors for timely treatment. Immigrant populations experienced longer delays from symptom onset to hospital arrival. The crucial roles of education and knowledge about stroke underscore the need for enhanced health literacy campaigns and public awareness, with a targeted focus on younger males and elderly females.

SOCIAL ISOLATION OF OLDER ADULTS WITH AND WITHOUT PHYSICAL HEALTH CONDITIONS DURING COVID-19

Abstract Older adults have been disproportionately affected by COVID-19. This study examined health care utilization and social isolation during the pandemic among older adults using written surveys and zoom and phone interviews. We compared two subgroups, those reporting physical health problems (N=12) and those reporting no health problems (N=6). Half of those with physical health problems reported postponing routine or elected healthcare as compared to four (66%) in the subgroup without physical health problems. Seven of 12 (58%) older adults with physical health problems reported isolation specifically from decreased participation in church even though as many lived either in a retirement community or with family, suggesting greater environmental or social supports. This compares to two (33%) in the subgroup without physical health problems reporting isolation from decreased participation in church with only one older adult living in a retirement community. Interviews identified three themes that complement these data: avoiding danger, compound stress (reported only among those with health problems (N=4)), and church as the largest event. These findings suggest that those with physical health problems were less able to delay seeking healthcare, were more likely to feel isolated when unable to attend church services, and suffered from compound stress due to the combination of public health directives and social unrest, such as the George Floyd protests. Religious, faith, or spiritual supports may be important buffers against social isolation during public health emergency, especially for older adults with physical health conditions and when there is concurrent social unrest.

The magnitude of health care seeking delay and associated factors for tuberculosis suggestive symptoms in Sidama Region Ethiopia: Community-based cross-sectional study

BackgroundHealth care seeking delay for tuberculosis suggestive symptoms is a great challenge for controlling the disease. Therefore, the study aimed to determine the magnitude and identify factors associated with delayed healthcare seeking among presumptive tuberculosis cases for suggestive tuberculosis symptoms. MethodsA community-based cross-sectional study was conducted among 476 subjects with symptoms suggestive of tuberculosis. Data were collected using a structured questionnaire, entered into Epi-data software version 3.1, and exported to SPSS software version 25.0 for analysis. The multivariable logistic regression models included variables like sex, marital status, knowledge, education level, and distance from health facility that show a significant association with health care seeking delay in the binary logistic regression at a P value 0.25. Tables, graphs, and charts were then used to display the results. ResultThe proportion of delayed health care seeking was found to be 46.7 % (95 % CI, 43.5–48.9). The study also revealed that being married, not attending formal education, having a lower monthly income, and having poor knowledge of tuberculosis were significantly associated with delayed tuberculosis-suggestive symptoms. ConclusionIn this study, delays in health care seeking among TB-suspected patients were high compared to the Ethiopian Ministry of Health target. Different systems should be built to increase community awareness of health care.

Delay in healthcare seeking for young children with severe pneumonia at Mulago National Referral Hospital, Uganda: A mixed methods cross-sectional study.

Globally, pneumonia is the leading infectious cause of under-five mortality, and this can be reduced by prompt healthcare seeking. Data on factors associated with delays in seeking care for children with pneumonia in Uganda is scarce. The study aimed to determine the prevalence, factors associated with delay, barriers, and facilitators of prompt healthcare seeking for children under five years of age with severe pneumonia attending Mulago National Referral Hospital (MNRH) Uganda. A mixed methods cross-sectional study was conducted among 384 caregivers of children with severe pneumonia at MNRH. Quantitative data was collected using interviewer-administered structured questionnaires and qualitative data through focus group discussions with caregivers. Descriptive statistics were used to determine the prevalence of delay in care seeking. Logistic regression analysis was used to determine the factors that were independently associated with delay in seeking healthcare. Content thematic analysis was used to analyze for barriers and facilitators of prompt healthcare seeking. The prevalence of delay in seeking healthcare was 53.6% (95% CI: 48.6-58.6). Long distance to a hospital (AOR = 1.94, 95% CI 1.22-3.01, p value = 0.003), first seeking care elsewhere (AOR = 3.33, 95% CI 1.85-6.01, p value = 0.001), and monthly income ≤100,000 UGX (28 USD) (AOR = 2.27,95% CI 1.33-3.86, p value = 0.003) were independently associated with delay in seeking healthcare. Limited knowledge of symptoms, delayed referrals, self-medication, and low level of education were barriers to prompt healthcare seeking while recognition of symptoms of severe illness in the child, support from spouses, and availability of money for transport were key facilitators of early healthcare seeking. This study showed that more than half of the caregivers delayed seeking healthcare for their children with pneumonia symptoms. Caregivers who first sought care elsewhere, lived more than 5 km from the hospital, and earned less than 28 USD per month were more likely to delay seeking healthcare for their children with severe pneumonia. Limited knowledge of symptoms of pneumonia, self-medication, and delayed referral hindered prompt care-seeking. Key facilitators of prompt care-seeking were accessibility to health workers, support from spouses, and recognition of symptoms of severe illness in children. There is a need for programs that educate caregivers about pneumonia symptoms, in children less than five years.

Risk predictive models of healthcare-seeking delay among imported malaria patients in Jiangsu Province based on the machine learning

To create risk predictive models of healthcare-seeking delay among imported malaria patients in Jiangsu Province based on machine learning algorithms, so as to provide insights into early identification of imported malaria cases in Jiangsu Province. Case investigation, first symptoms and time of initial diagnosis of imported malaria patients in Jiangsu Province in 2019 were captured from Infectious Disease Report Information Management System and Parasitic Disease Prevention and Control Information Management System of Chinese Center for Disease Control and Prevention. The risk predictive models of healthcare-seeking delay among imported malaria patients were created with the back propagation (BP) neural network model, logistic regression model, random forest model and Bayesian model using thirteen factors as independent variables, including occupation, species of malaria parasite, main clinical manifestations, presence of complications, severity of disease, age, duration of residing abroad, frequency of malaria parasite infections abroad, incubation period, level of institution at initial diagnosis, country of origin, number of individuals travelling with patients and way to go abroad, and time of healthcare-seeking delay as a dependent variable. Logistic regression model was visualized using a nomogram, and the nomogram was evaluated using calibration curves. In addition, the efficiency of the four models for prediction of risk of healthcare-seeking delay among imported malaria patients was evaluated using the area under curve (AUC) of receiver operating characteristic curve (ROC). The importance of each characteristic was quantified and attributed by using SHAP to examine the positive and negative effects of the value of each characteristic on the predictive efficiency. A total of 244 imported malaria patients were enrolled, including 100 cases (40.98%) with the duration from onset of first symptoms to time of initial diagnosis that exceeded 24 hours. Logistic regression analysis identified a history of malaria parasite infection [odds ratio (OR) = 3.075, 95% confidential interval (CI): (1.597, 5.923)], long incubation period [OR = 1.010, 95% CI: (1.001, 1.018)] and seeking healthcare in provincial or municipal medical facilities [OR = 12.550, 95% CI: (1.158, 135.963)] as risk factors for delay in seeking healthcare among imported malaria cases. BP neural network modeling showed that duration of residing abroad, incubation period and age posed great impacts on delay in healthcare-seek among imported malaria patients. Random forest modeling showed that the top five factors with the greatest impact on healthcare-seeking delay included main clinical manifestations, the way to go abroad, incubation period, duration of residing abroad and age among imported malaria patients, and Bayesian modeling revealed that the top five factors affecting healthcare-seeking delay among imported malaria patients included level of institutions at initial diagnosis, age, country of origin, history of malaria parasite infection and individuals travelling with imported malaria patients. ROC curve analysis showed higher overall performance of the BP neural network model and the logistic regression model for prediction of the risk of healthcare-seeking delay among imported malaria patients (Z = 2.700 to 4.641, all P values < 0.01), with no statistically significant difference in the AUC among four models (Z = 1.209, P > 0.05). The sensitivity (71.00%) and Youden index (43.92%) of the logistic regression model was higher than those of the BP neural network (63.00% and 36.61%, respectively), and the specificity of the BP neural network model (73.61%) was higher than that of the logistic regression model (72.92%). Imported malaria cases with long duration of residing abroad, a history of malaria parasite infection, long incubation period, advanced age and seeking healthcare in provincial or municipal medical institutions have a high likelihood of delay in healthcare-seeking in Jiangsu Province. The models created based on the logistic regression and BP neural network show a high efficiency for prediction of the risk of healthcare-seeking among imported malaria patients in Jiangsu Province, which may provide insights into health management of imported malaria patients.

Children presenting with diabetes and diabetic ketoacidosis to Emergency Departments during the COVID-19 pandemic in the UK and Ireland: an international retrospective observational study

ObjectivesTo describe the incidence of new onset paediatric diabetes mellitus, clinical characteristics and patterns of presentation to emergency departments (ED) during the COVID-19 pandemic, and to assess whether this increase...

Nurses' preparedness for disaster response in rural and urban primary healthcare settings in Tanzania.

Nurses are often on the frontline of disaster management, providing care to patients with emerging physical, mental, and emotional turbulence, and acting as educators for health promotion and disaster prevention in both rural and urban contexts. However, the literature suggests that nurses are inadequately prepared for disaster response. This study examined preparedness for disaster response among nurses in rural and urban primary healthcare settings in Tanzania. This qualitative descriptive study involved purposefully selected qualified nurses and nurse administrators working in rural (n=20) and urban (n=11) primary healthcare facilities in Tanzania. Telephone-based interviews were conducted to gather data that were then analyzed thematically. Five themes emerged from the analysis: previous experiences, technical capacity, current strategies, challenges, and overall preparedness. Previous experiences included personally caring for victims, working in disaster response teams, working in administrative roles during disasters, and conducting community sensitization. Most nurses in rural contexts had not received training on disaster response and relied on past experience, knowledge from nursing school, observing peers, and knowledge from the internet and movies. Current strategies for disaster response included response teams (although these were considered 'weak'), ensuring the availability of equipment and supplies, and infrastructure for victim management. Challenges in disaster response included inadequate resources, understaffing, lack of expertise at primary healthcare facilities, nurses tasked with multiple responsibilities, inadequate technical capacity, fears of infection, poor interpersonal relationships, inadequate community knowledge, poor reporting systems, delayed healthcare seeking, long distances to facilities, and poor road infrastructure. These challenges were more pronounced in rural settings. Most nurses felt they were well prepared to respond to disasters, although this appeared to be rooted in a willingness to provide care rather than having adequate knowledge, skills, and resources for disaster response. Suggestions for better preparing nurses for disaster response included training, increasing essential equipment and medical supplies, increasing the nursing workforce, improving reporting systems, disseminating local guidelines, strengthening disaster response teams, and improving the nursing training curricula to cover disaster management. A range of institutional, individual, and community challenges affect nurses' preparedness for disaster response in rural and urban primary healthcare settings. Addressing these challenges requires multiple strategies that extend beyond the capacity building of nurses to strengthen health system disaster preparedness in general, prioritizing rural contexts.

A comprehensive health-promoting neighborhood intervention to improve health care seeking behavior among reproductive age Iranian women

BackgroundWomen’s health care seeking delays remains an unresolved major public health problem in developing and underdeveloped countries. This study aimed to evaluate a health-promoting neighborhood intervention to improve health care seeking behavior (HCSB) among reproductive age Iranian women using Health Promotion Model (HPM).MethodThis randomized controlled trial was conducted on 160 women of reproductive age in two groups: experimental and control. Data were collected by self-administered questionnaire based on HPM constructs and a medical symptom checklist. A health-promoting neighborhood intervention was performed in seven sessions for the experimental group. HCSB and HPM constructs were measured before and 3 months after intervention in the two groups. p < 0.05 was considered significant level.ResultsThe average mean age of participants was 30.45 ± 7.80 years. After intervention, the mean score of self-efficacy, interpersonal influences, commitment to plan and HCSB was increased significantly in women in the experimental group, while negative constructs such as perceived barriers, negative activity-related affect, and immediate competing demands and preferences significantly decreased (p < 0.05). In addition, the mean score of referring for symptoms such as excessive sweating, persistent fatigue or weakness, headache, bleeding or spotting between periods, vaginal itching and irritation, unusual vaginal discharge, flashing, chest pain, rapid heartbeats, aching muscles or joints, urinary problems and some mental disorder was increased significantly in experimental group compared to control group (p < 0.05).ConclusionsThe results of study show that an intervention based on the HPM have a positive impact on HCSB and its associated factors and can help improve women’s health behaviors and health outcomes.

Perception and Predictors of Spousal Involvement in Antenatal Care by Women Attending Immunization Clinic at Babcock University Teaching Hospital, Ogun State, Nigeria

ABSTRACT Background: The level of spousal involvement in antenatal care (ANC) is not what it should be. This is a concern because a number of preventable maternal and neonatal mortality or morbidity can be attributed to a lack of interest or participation in ANC by their spouses, which usually result in a delay in seeking healthcare and/or delay in reaching a healthcare facility. Aim: To assess the degree of spousal involvement in ANC among women accessing care at the Immunization Clinic in Babcock University Teaching Hospital (BUTH), Ogun State, Nigeria. Patients and Methods: This was a descriptive cross-sectional study. Two hundred and sixty-eight (268) women who attended the antenatal clinic in their last pregnancy participated in the study. Semi-structured questionnaires were administered in an interview-based manner to each participant. Data were entered and analyzed using IBM Statistical Package for Social Sciences (SPSS version 22.0). Results: There was good spousal involvement (56%) in ANC. Statistically significant associations were found between the age, education level, occupation, and income of the spouses and their involvement (P &lt; 0.05). Conclusion: Spousal involvement in ANC in this study was above average. Measures that can consolidate the identified predictors of good spousal involvement in ANC should be adopted.

Factors associated with delay in seeking healthcare for imported malaria: a retrospective study in a French hospital.

Delayed treatment is associated with a higher risk of severe malaria. In malaria-endemic areas, the main factors associated with delay in seeking healthcare are low educational level and traditional beliefs. In imported malaria, determinants of delay in seeking healthcare are currently unknown. We studied all patients presenting with malaria, from 1 January 2017 to 14 February 2022, in the hospital of Melun, France. Demographic and medical data were recorded for all patients, and socio-professional data were recorded for a subgroup of hospitalized adults. Relative-risks and 95% confidence intervals were determined using univariate analysis by cross-tabulation. There were 234 patients included, all travelling from Africa. Among them, 218 (93%) were infected with P. falciparum, 77 (33%) had severe malaria, 26 (11%) were <18years old and 81 were included during the SARS-CoV-2 pandemic. There were 135 hospitalized adults (58% of all patients). The median time to hospital admission (THA) , defined by the period from onset of symptoms to arrival at hospital, was 3days (IQR = 2-5). A THA ≥3days tended to be more frequent in travellers visiting friends and relatives (VFR; RR = 1.44, 95% CI = [1.0-2.05], P = 0.06), while it was less frequent in children and teenagers (RR = 0.58, 95% CI = [0.39-0.84], P = 0.01). Gender, African background, unemployment, living alone and absence of referring physician were not associated with delay in seeking healthcare. Consulting during the SARS-CoV-2 pandemic was neither associated with a longer THA nor with a higher rate of severe malaria. In contrast to an endemic area, socio-economic factors did not impact on delay in seeking healthcare in imported malaria. Prevention should focus on VFR subjects, who tend to consult later than other travellers.

Impact of a Community Empowerment Intervention on Sexually Transmitted Infections Among Female Sex Workers in Baltimore, Maryland.

Female sex workers ( FSWs) are vulnerable to a number of health issues, but often delay seeking health care due to structural barriers. Multiservice drop-in centers have been shown to increase FSW access to health services globally, but their impact on FSW in the United States is lacking. This study seeks to evaluate the effect of a community-level empowerment intervention (the multiservice drop-in SPARC center) on cumulative sexually transmitted infections (STIs) among FSW in a city in the United States. Between September 2017 and January 2019, 385 FSWs were recruited in Baltimore. Participants from areas served by SPARC were recruited to the intervention; other areas of Baltimore were the control. Follow-up occurred at 6, 12, and 18 months. The primary outcome is cumulative STI (ie, positive gonorrhea or chlamydia test at any follow-up). We tested effect modification by condomless sex with paying clients reported at baseline. Logistic regressions with propensity score weighting were used to estimate intervention effect, accounting for loss to follow-up, with bootstrap confidence intervals. Participants completed 713 follow-up study visits (73%, 70%, 64% retention at 6, 12, and 18 months, respectively). Baseline STI prevalence was 28% and cumulative STI prevalence across follow-ups was 26%; these both did not differ between control and intervention communities in bivariate analyses. After adjusting for covariates, FSW in the intervention had a borderline-significant decrease in odds of cumulative STI compared with control (odds ratio, 0.61, P = 0.09 ) . There was evidence of effect modification by baseline condomless sex, such that FSW in the intervention who reported condomless sex had lower odds of cumulative STI compared with FSW in the control community who also reported baseline condomless sex (odds ratio, 0.29; P = 0.04). Results demonstrate the value of a low-barrier, multiservice model on reducing STIs among the highest-risk FSW.Clinical Trial Number: NCT04413591.

Perceptions of stigma among pulmonary tuberculosis patients in Thailand, and the links to delays in accessing healthcare.

Delay in seeking care increases the morbidity and mortality in tuberculosis (TB) patients and leads to increased likelihood of transmission within the community. Stigmatisation is one of the influencing factors causing delay in accessing healthcare when experiencing symptoms of TB. This study aimed to explore the relationship between TB stigmatisation and patient delay among pulmonary tuberculosis (PTB) patients. A mixed methods study was undertaken among 300 randomly sampled participants who completed questionnaire surveys, supplemented by 25 in-depth interviews with purposively-sampled participants identified as delaying access to healthcare. Participants reporting higher perceived levels of TB stigmatisation demonstrated a longer duration of patient delay (p < 0.001). Qualitative data reinforced the view that perceptions of TB as being a disease carrying with it a stigma contributed to a delay in seeking healthcare. This was also exacerbated in patients with HIV-positive. Given that HIV-positive status is still subject to stigma in some parts of society, patients demonstrated additional reluctance to seek out healthcare if they were known to be HIV-positive whilst also experiencing symptoms of TB. The study highlights that accurate and objective information about TB is required to reduce societal stigmatisation related to the disease, thereby reducing the reluctance of patients to access healthcare.

Chronic Disease Screening and Health Promotion Strategies for Older Men

The population of older men is increasing. Care of male patients has often been overlooked in practice and research. Older men have increased rates of cardiovascular disease, undiagnosed depression, and suicide, and avoid scheduling routine health visits or delay seeking health care. Nurse practitioners can use evidence-based screening recommendations to identify, treat, and manage chronic conditions in older men to improve their overall health and life expectancy. This report focuses on chronic conditions in older men with high rates of morbidity and mortality and provides updated guidelines to assist nurse practitioners to provide optimal care of their older male patients.

Knowledge, experiences, and practices of women affected by female genital schistosomiasis in rural Madagascar: A qualitative study on disease perception, health impairment and social impact.

Female genital schistosomiasis (FGS) is a neglected manifestation of urogenital schistosomiasis caused by S. haematobium. The disease presents with symptoms such as pelvic pain, vaginal discharge and bleeding and menstruation disorders, and might lead to infertility and pregnancy complications. The perspectives of women with FGS have not been studied systematically. The aim of the study was to understand knowledge, experiences, and practices of women with FGS. We performed a qualitative study with seventy-six women diagnosed of having FGS, in the Ambanja district in Northwest Madagascar. Data collection was either through focus group discussion (N = 60) or in an individual semi-structured interview (N = 16). FGS was diagnosed by colposcopy. The data was analysed using Mayring´s qualitative content analysis. Knowledge on how the disease is acquired varied and ideas on prevention remained vague. Patients suffered from vaginal discharge and pelvic complaints. Some women expressed unbearable pain during sexual intercourse and compared their pain to an open wound being touched. FGS considerably impaired women´s daily activities and their quality of life. Infertility led to resignation and despair, conflicts with the partner and to social exclusion from the community. Women fearing to sexually transmit FGS refrained from partnership and sexual relations. Many women with FGS reported stigmatisation. A coping strategy was to share strain with other women having similar complaints. However, concealing FGS was a common behaviour which led to social isolation and delayed health care seeking. Our study underlines that FGS has an important impact on the sexual health of women and on their social life in the community. Our results highlight the importance of providing adequate health education and structural interventions, such as the supply of water and the provision of sanitation measures. Further, correct diagnosis and treatment of FGS in adolescent girls and women should be available in all S. haematobium-endemic areas. The qualitative study was embedded in a randomised controlled trial (RCT) in which two doses of praziquantel were compared (https://clinicaltrials.gov/ct2/show/NCT04115072).