Health Seeking Behaviour Research Articles

Individual- and community-level predictors of healthcare-seeking behaviour for acute respiratory tract infections among children under five in 29 low- and middle-income countries: a multilevel analysis

ObjectivesThis study aimed to identify the individual- and community-level determinants of mothers’ healthcare-seeking behaviour for children under the age of 5 years with acute respiratory infection (ARI) symptoms in low-and middle-income countries (LMICs). Study designNationally representative Demographic and Health Survey datasets from 29 LMICs were used. MethodsThe study included 16,893 children aged under 5 years with ARI symptoms in the 2 weeks prior to the survey. A multilevel logistic regression model was used to examine associations between individual- and community-level factors with health-seeking behaviour for ARIs. The adjusted odds ratio (AOR) along with 95% confidence intervals (CIs) were reported as a measure of association. ResultsThe overall prevalence of healthcare-seeking behaviour for ARIs among children under 5 years in LMICs was 58.83% (95% CI: 58.08, 59.57). Findings showed that mothers with primary or higher education (AOR = 1.20; 95% CI: 1.08, 1.33), and those residing in rich households (AOR = 1.32; 95% CI: 1.18, 1.48), attending antenatal care (ANC) visits (AOR = 1.53; 95% CI: 1.31, 1.79) and delivering at a healthcare facility (AOR = 1.28; 95% CI: 1.16, 1.41) were more likely to seek healthcare for ARIs. A higher level of community maternal education (AOR = 1.44; 95% CI: 1.24, 1.68) was positively associated with seeking healthcare for ARIs, while a higher level of community poverty (AOR = 0.83; 95% CI: 0.72, 0.96) was negatively associated with healthcare seeking for ARIs. ConclusionsThis study revealed that mothers’ healthcare-seeking behaviour for ARIs was closely linked to modifiable risk factors, including maternal education, household wealth, use of maternal health services (e.g., ANC), as well as community poverty and literacy levels. Future interventions should consider these modifiable risk factors when developing strategies to improve child health outcomes in LMICs.

Identifying markers of health-seeking behaviour and healthcare access in UK electronic health records

ObjectiveTo assess the feasibility of identifying markers of health-seeking behaviour and healthcare access in UK electronic health records (EHR), for identifying populations at risk of poor health outcomes and adjusting...

Association of female sex with cataract surgery in the general population but not in plaque brachytherapy-treated uveal melanoma patients

Cataract is a leading cause of blindness worldwide, necessitating a deeper understanding of its risk factors. We analyzed two cohorts: 1000 individuals from the general Swedish population and 933 patients who received plaque brachytherapy for uveal melanoma. Using Kaplan-Meier and cumulative incidence analyses, as well as Cox and competing risk regressions, we assessed whether there is a relationship between sex and cataract surgery. In the general population, female sex was a significant risk factor for cataract surgery, with a 10-year incidence of 16% compared to 10% for males (subdistribution hazard ratio adjusted for age, 1.35, P < 0.001). In the brachytherapy cohort, female sex was not associated with an increased incidence of cataract surgery, with a 10-year incidence of 25% versus 23% for males (HR 1.08, P = 0.61). Visual acuity at the time of cataract surgery did not significantly differ between sexes in either cohort, suggesting that differences in surgery rates are not due to health-seeking behavior or surgery assessment thresholds. These findings indicate that female sex is associated with a higher risk of cataract surgery in the general population, but not among those treated with plaque brachytherapy for uveal melanoma.

The Prevalence of Migraine Headache and the Health-Seeking Behavior of Medical Undergraduates in Punjab

The Prevalence of Migraine Headache and the Health-Seeking Behavior of Medical Undergraduates in Punjab

Abstract B144: Conceptual framework on health behaviors and experiences of Sub-Saharan African immigrant prostate cancer survivors

Abstract Background: Sub-Saharan African immigrants (SSAI) in the United States (US) constitute one of the fastest-growing segments of the immigrant population. Between 2010 and 2018, the SSAI population in the US increased by 53%, significantly outpacing the 12% growth rate for the overall foreign-born population in the US during that period. We define SSAI as the 2 million individuals living in the US originally from the region of the African continent located south of the Saharan desert. Despite their growing numbers, little is published about the extent to which SSAI adapt to health behaviors more common in the US or remain immersed in the values, beliefs, and practices reflective of their country of origin. Importantly, no study has comprehensively examined the social determinants of health factors among this population and its influence on health-seeking behaviors and decision-making regarding prostate cancer care and treatment. Aim: This study seeks to better understand the lived experiences, unmet needs and the impact of migration on the quality of life of SSAI cancer survivors in the US. Methods. We employ a qualitative approach guided by grounded theory. Selective sampling was used to identify potential participants from a database obtained via the Florida and Minesota cancer registries. We proceeded to conduct in-depth interviews with 16 cancer survivors recruited from the two caner registries. Results. We developed a conceptual framework illuminating the full range of social, behavioral, environmental, and structural factors associated with the experiences of SSAI prostate cancer survivors. From the data, the post diagnosis experiences of study participants can be categorized into three domains: 1) health behaviors; 2) treatment decision and antecedents; 3) challenges of being an immigrant. Characteristics of health behaviors include using informal care teams for social support and second opinions before treatment. Selective disclosure of diagnosis, changes to diet, exercise and searching for information about the diseases were other manifestation of behavior. While some participants made decisions about treatment soon after diagnosis, others took a more deliberative approach and relied on faith and family for social support. Some challenges in terms of being an immigrant include knowledge gaps about the US health system, lack of health insurance and transportation to hospital during treatment. Implication for public health practice. Some of the unmet needs of study participants include transportation cost to and from hospital for radiotherapy and other treatment and reducing the high out of pocket cost for co-payment and drugs. The knowledge deficit about navigating the US health system can be addressed through community-based intervention in partnerships with immigrant groups, advocacy organizations and faith-based organizations. The focus of this intervention should be to educate and empower SSAI men on how to navigate the US health system and be more assertive about their health needs and desires for treatment during doctor’s visit. Citation Format: Ernie Kaninjing, Gladys Asiedu, Kaitlin Van Voorhis, Daniel Lee, Rakinya Hinson, Mary Ellen Young. Conceptual framework on health behaviors and experiences of Sub-Saharan African immigrant prostate cancer survivors [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr B144.

Exploring Smokers Perspectives on Health Status and Health Seeking Behavior: A Qualitative Exploration

Objective: Smokers might tend to ignore when communicating about smoking health risks. We used Bourdieu’s conceptual tool to guide and explore their perception of being healthy despite their smoking behavior and their health seeking practice. Material and Methods: A qualitative method, using a semi-structured interview as the main method of collecting the data, was used. This method was implemented because of its flexibility in the exploration, based on participant responses. Results: The findings are reported as per the thematic analysis of 15 purposively selected participants. The ages of the 15 participants varied from 20 to 55 years old, and they were selected from the quantitative study to participate voluntarily in this qualitative exploration. Among them, 14 were males and one was female. The ethnic representation in this qualitative part were Malays (n=14) and Chinese (n=1). The duration of smoking varied in the sample, with the majority smoking for more than five years. Conclusion: This study better understands smokers’ health perception and their health-seeking behavior. Firstly, the perception of the less harmful effects of smoking on the health of smokers was understood within the views of Bourdieu’s Theory of Cultural Health Capital, which, in turn poses challenges to smoking cessation programs and campaigns. This study reported that smokers perceived themselves as healthy, and thus continued their smoking habit despite knowing its side effects.

Characterization of the Elderly Patients Admitted with Infection to a Tertiary Hospital in Bangladesh

Background: The proportion of hospitalizations attributable to infectious diseases is high, and likely to increase further in the future as a result of the expected aging of the population and the increasing prevalence of comorbid conditions among the elderly. The present study aimed to investigate the clinical characteristics and outcomes of elderly patients admitted due to infection in a tertiary-level hospital in Chattogram, Bangladesh. Materials and methods: This prospective observational study was conducted in Chittagong Medical College Hospital (CMCH) Chattogram. Two hundred and six patients aged ≥60 admitted with a diagnosis of infectious aetiology in the medicine department were enrolled according to set inclusion criteria. Patients were followed up for in-hospital outcomes after admission. Results: Age ranges from 60-90 years with a mean age of 65.82 (±5.56) years) and 51.5% were male. Pre-hospital antibiotic was received by 108 (52.4%) patients and 7.4% had antibiotic prescribed by registered physicians The most frequent infections were respiratory tract infections (47.6%) and urinary tract infections (43.2%). Sixty-four (31.1%) patients developed sepsis and 17 (8.3%) required ICU support. Eleven patients expired in-hospital, indicating a mortality rate of 5.3%. Length of hospitalization ranged from 2 to 17 days, with a median of 6 days. Conclusion: This study result suggests that infection-related hospitalization and outcomes of elderly individuals were high and their health seeking behaviour was poor. IAHS Medical Journal Vol 6(2), December 2023; 31-34

Morbidity Patterns and Health Seeking Behaviour of 50+ Elderly People in the Rural Community at Fateyabad in Chattogram

Background: Bangladesh is a nation with 9.3% geriatric population who are above 60 years of age and it is expected to rise to 22% in 2050. Health related problems of the elderly need comprehensive geriatric care. This study aimed to explore the morbidity pattern and its associated factors among the elderly population in a rural area of the Chattogram district of Bangladesh. Materials and methods: A cross-sectional study was conducted at Fateyabad in Hathazari, Chattogram, during the period from April to October 2023 which included 260 respondents aged 50 years and above. Data were collected by face-to-face interview by using a pretested mixed type questionnaire. Data were compiled and analysis were done by using scientific calculator and computer. Results: HTN and Diabetes Mellitus were the most common morbidities among elderly population which was 151 (58%) and 92 (35%) respectively. Female respondents were 143 (55%) and male were 117 (45%). Majority of the elderly population belonged to age group 50-59 which was 160 (61%) years and lion share of the respondents were housewife 134 (51%). The rates of seeking healthcare services was higher among elderly population with primary and secondary education, those living with spouses and children, those residing in extended families with seven or more members and older men and women with diabetes and cardiac diseases. Conclusion: On the basis of the findings, it is suggested that the traditional extended family structure should be sustained, wherein older people are treated with care and respect, thereby promoting health of the aged in rural Bangladesh. Furthermore, family relationships should be strengthened, because older individuals, require emotional and familial support to their end stage of life. IAHS Medical Journal Volume 6(2) December 2023; 64-67

Emergency admission predictive risk stratification models: assessment of implementation consequences (PRISMATIC 2): protocol for a mixed methods study.

Emergency admissions are costly, increasingly numerous, and associated with adverse patient outcomes. Policy responses have included the widespread introduction of emergency admission risk stratification (EARS) tools in primary care. These tools generate scores that predict patients' risk of emergency hospital admission and can be used to support targeted approaches to improve care and reduce admissions. However, the impact of EARS is poorly understood and there may be unintended consequences. To assess effects, mechanisms, costs, and patient and healthcare professionals' views related to the introduction of EARS tools in England. Quasi-experimental mixed methods design using anonymised routine data and qualitative methods. We will apply multiple interrupted time series analysis to data, aggregated at former Clinical Commissioning Group level, to look at changes in emergency admission and other healthcare use following EARS introduction across England. We will investigate GP decision-making at practice level using linked general practice and secondary care data to compare case-mix, demographics, indicators of condition severity and frailty associated with emergency admissions before and after EARS introduction. We will undertake interviews (n~48) with GPs and healthcare staff to understand how patient care may have changed. We will conduct focus groups (n=2) and interviews (n~16) with patients to explore how they perceive that communication of individual risk scores might affect their experiences and health seeking behaviours. Findings will provide policymakers, healthcare professionals, and patients, with a better understanding of the effects, costs and stakeholder perspectives related to the introduction of EARS tools.

Machine Learning Analysis of Radio Data to Uncover Community Perceptions on the Ebola Outbreak in Uganda

Radio is vital for people, especially in rural areas, to share their concerns through interactive talk shows. Understanding public perceptions of pandemics is crucial because they influence people’s attitudes and health-seeking behaviors. This study used machine learning to analyze English and Luganda radio broadcast data to understand public perceptions and perspectives on the Ebola outbreak in Uganda. Our findings revealed three main speaker categories: media personalities, community guests and listeners, and government officials. The government made the most significant effort to educate the public about the Ebola outbreak. The analysis showed that the community was hesitant to use Ebola vaccines, believing that they had not been tested on other populations where the Ebola virus had originated. The community was also concerned about the effects of the lockdown measures imposed during the COVID-19 pandemic. The analysis of the radio broadcast data revealed differences in the timing and content of the conversations between male and female speakers. These experiences can inform population-specific policies for handling ongoing and future pandemics.

Health-seeking behaviours of the families with older adults during the COVID-19 epidemic in rural China: a qualitative inquiry from the perspective of migration and social support networks

IntroductionHealth behaviours during a public health crisis for families with vulnerable ageing relatives are worth studying. After the Chinese government’s zero-tolerance policy on COVID-19 ended at the close of 2022,...

Mother's Experiences in Caring for Children with Stunting in Rural Indonesia.

Stunting is a major health problem in Indonesia. The aim of this study is to explore the experiences of mothers who take care of stunted children in rural Pamekasan Madura, Indonesia. This research employed a phenomenological approach and conducted in-depth interviews with 11 mothers in rural Pamekasan Madura, Indonesia, using purposive sampling. Data collection took place from June to September 2023. This study presents Madurese mothers' experiences caring for their children with stunting through two themes and five sub-themes: (a) beliefs passed down for generations: strong ancestral influence on feeding behaviors, traditional food, and traditional health-seeking behavior; and (b) insufficient resources on nutrition: a lack of time and money to provide nutrition-rich food and a lack of nutrition information. Cultural beliefs, a lack of nutrition education, and economic barriers contribute to stunting in children. Our findings guide the design of tailored interventions for preventing stunting in Indonesian families and global communities.

Beliefs of Pentecostal pastors concerning the use of antiretroviral treatment among Pentecostal Christians living with HIV in a suburb of Cape Town-South Africa: a community health systems lens.

The global public health community accepts antiretroviral therapy (ART) for controlling and managing HIV. However, within some communities, claims of faith or miraculous healing of HIV and AIDS by Pentecostal pastors continue to spark controversies. This paper reports on an exploratory qualitative study to explore the beliefs held by Pentecostal pastors regarding the use of ART among Pentecostal Christians who are living with HIV (PCLH). Twenty Pentecostal pastors from two informal settlements in Cape Town, South Africa, were purposefully selected. Open-ended, semi-structured, in-depth individual interviews were conducted on their religious beliefs concerning ART adherence. Interviews were conducted in English, audiotaped, and transcribed verbatim before being imported to the Atlas-ti 2023 software program for thematic data analysis. Since our study was guided by the relational community health system (CHS) model a hybrid deductive-inductive thematic analysis was used. Two contrasting themes about the influence of the religious beliefs of Pentecostal pastors were identified: The first theme and its associated subthemes highlight the lack of basic HIV and ART knowledge among pastors. Consequently, these pastors tend to nudge their Christians to rely more on faith and spiritual healing at the expense of adherence to ART. The second theme and the associated sub-themes suggest that some pastors possess some basic HIV knowledge and understand the role of ART and how it works. This group of pastors advise their congregants to use ART and other healthcare services in tandem with spiritual rituals, faith, and prayers. Our findings highlight the need for functional community-based structures, such as community health committees (CHCs) and health facility management committees (HFMCs), in settings where complex interaction within the belief systems, practices, and norms of some stakeholders can influence people's health-seeking behaviours such as adhering to chronic medications like ART.

Does contracting family doctor promote primary healthcare utilization among older adults? - evidence from a difference-in-differences analysis

IntroductionIn 2016, the Chinese government officially scaled up family doctor contracted services (FDCS) scheme to guide patients’ health seeking behavior from tertiary hospitals to primary health facilities.MethodsThis study evaluated the overall gate-keeping effects of this scheme on healthcare utilization of rural residents by using a difference-in-differences (DiD) design. The analysis was based on Shandong Rural Elderly Health Cohort 2019 and 2020. Participants who contracted FDCS in second round and were not contracted with a family doctor in the first round were regarded as treatment group. In total, 310 respondents who have used medical care were incorporated for final study.ResultsParticipants who contracted FDCS (treatment group) experienced a significant decline in the mean level of first-contact health-care facilities, decreasing from 2.204 to 1.981. In contrast, participants who did not contract FDCS (control group), showed an increasing trend in the mean level of first-contact health-care facilities, rising from 2.128 to 2.445. Our results showed that contracting FDCS is associated with approximately 0.54 extra lower mean level of first-contact health-care facilities (P = 0.03, 95% CI: -1.03 to 0.05), which suggests an approximately 24.5% reduction in the mean first-contact health-care facility level for participants compared with contracted FDCS than those who did not.ConclusionsThe study suggested primary healthcare quality should be strengthened and restrictive first point of contact policy should be enacted to establish ordered healthcare seeking behavior among rural residents.

Effectiveness of WhatsApp based debunking reminders on follow-up visit attendance for individuals with hypertension: a randomized controlled trial in India

BackgroundIndividuals with high blood pressure in India often miss essential follow-up visits. Missed visits contribute to gaps across the hypertension care continuum and preventable cardiovascular disease. Widespread misconceptions around hypertension care and treatment may contribute to low follow-up attendance rates, but to date, there is limited evidence of the effect of interventions to debunk such misconceptions on health-seeking behavior. We conducted a randomized controlled trial to measure whether combining information debunking commonly-held misconceptions with a standard reminder reduces missed follow-up visits among individuals with high blood pressure and investigated whether any observed effect was moderated through belief change.MethodsWe recruited 388 patients with uncontrolled blood pressure from the outpatient wards of two public sub-district hospitals in Punjab, India. Participants randomly assigned to the intervention arm received two WhatsApp messages, sent 3 and 1 days before their physician-requested follow-up visit. The WhatsApp message began with a standard reminder, reminding participants of their upcoming follow-up visit and its purpose. Following the standard reminder, we included brief debunking statements aimed at acknowledging and correcting common misconceptions and misbeliefs about hypertension care seeking and treatment. Participants in the control group received usual care and did not receive any messages.ResultsWe did not find evidence that the enhanced WhatsApp reminders improved follow-up visit attendance (Main effect: 2.2 percentage points, p-value = 0.603), which remained low across both treatment (21.8%, 95% CI: 15.7%, 27.9%) and control groups (19.6%, 95% CI: 14.2%, 25.0%). Participants had widespread misconceptions about hypertension care but our debunking messages did not successfully correct these beliefs (p-value = 0.187).ConclusionsThis study re-affirms the challenge of continuity of care for chronic diseases in India and suggests that simple phone-based health communication methods may not suffice for changing prevalent misconceptions and improving health-seeking behavior.Trial registrationThe trial began on July 18th. We registered the trial on July 18th (before recruitment began), including the main outcomes, on the German Clinical Trial Register [Identifier: DRKS00029712] and published a pre-analysis plan in the Open Science Framework [osf.io/67g35].

Epidemiology of Prostate Cancer in Africa: An In-Depth Review

Prostate cancer is a major health challenge in Africa, presenting significant regional disparities in incidence and outcomes. This review provides an in-depth examination of the epidemiology of prostate cancer on the continent, considering a range of factors that influence its prevalence and management. Genetic predispositions, including mutations in BRCA1, BRCA2, and HOXB13, play a crucial role, with African populations displaying unique genetic variants contributing to higher incidence rates. Environmental and lifestyle factors, such as diet, physical activity, and substance use, also impact prostate cancer risk. Traditional African diets, rich in fruits and vegetables, may offer protective benefits, while modern dietary patterns and sedentary lifestyles are linked to increased risk. Socioeconomic determinants, including access to healthcare, educational attainment, and financial barriers, significantly affect diagnosis and treatment, often leading to late-stage presentations. Hormonal and biological factors, such as androgen levels and age-related changes, further influence disease development. Infections, inflammatory conditions, and occupational exposures also contribute to risk. Cultural and behavioral influences, including traditional beliefs and health-seeking behaviors, impact prevention and management strategies. The review highlights the challenges faced by healthcare infrastructure and screening programs, emphasizing the need for improved access, public awareness, and tailored interventions. Addressing these factors through comprehensive public health strategies, including enhanced screening, lifestyle modifications, and cultural sensitivity, is essential for improving prostate cancer outcomes across Africa. Keywords: Epidemiology, Prostate Cancer, Africa, Genetic, Biological factor.

Protecting maternal health: Strategies against HIV and malaria in pregnancy.

Maternal health remains a global priority, with particular emphasis on combating infectious diseases such as HIV and malaria during pregnancy. Despite significant progress in prevention and treatment efforts, both HIV and malaria continue to pose significant risks to maternal and fetal well-being, particularly in resource-limited settings. The prevention of mother-to-child transmission (PMTCT) programs for HIV and intermittent preventive treatment (IPTp) for malaria represent cornerstone strategies in mitigating the impact of these infections on pregnancy outcomes. PMTCT programs focus on early HIV diagnosis, antiretroviral therapy initiation, and promoting safe infant feeding practices to reduce the risk of mother-to-child transmission. Similarly, IPTp involves the administration of antimalarial medication to pregnant women in malaria-endemic regions to prevent maternal and fetal complications associated with malaria infection. Integration of HIV and malaria prevention and treatment services within existing maternal and child health programs is crucial for maximizing impact and minimizing healthcare system strain. Strengthening health systems, improving access to antenatal care services, and enhancing community engagement are essential components of comprehensive maternal health strategies. Furthermore, promoting awareness, education, and empowerment of pregnant women and communities are vital in fostering health-seeking behaviors and adherence to preventive measures against HIV and malaria. In conclusion, protecting maternal health from the dual threat of HIV and malaria requires a multifaceted approach that encompasses prevention, screening, treatment, and community engagement.

Strengthening the effectiveness of community health system: Assessing the factors that enhance or constrain the delivery of health services within communities in Nigeria

IntroductionSub-optimal community health service delivery (CHSD) has been a challenge constraining community health systems (CHS) globally, especially in developing countries such as Nigeria. This paper examined the key factors that either enhance or constrain CHSD in Nigeria at the individual, community/facility and governmental levels while recommending evidence-based solutions for sustaining and improving CHSD within the framework of CHS.MethodsData were collected through a qualitative study undertaken in three states (Anambra, Akwa-Ibom and Kano) in Nigeria. Respondents were formal/informal health providers, community leaders and representatives of civil society organizations all purposively sampled. There were 90 in-depth interviews and 12 focus group discussions, which were audio-recorded, transcribed verbatim and analysed thematically using codes to identify key themes.ResultsFactors constraining community health service delivery at the individual level were poor health-seeking behaviour, preference for quacks and male dominance of service delivery; at the community/facility level were superstitious/cultural beliefs and poor attitude of facility workers; at the governmental level were inadequate financial support, embezzlement of funds and inadequate social amenities. Conversely, the enabling factors at the individual level were community members’ participation and the compassionate attitude of informal providers. At the community and facility levels, the factors that enhanced service delivery were synergy between formal and informal providers and support from community-based organizations and structures. At the governmental level, the enhancing factors were the government’s support of community-based formal/informal providers and a clear line of communication.ConclusionsCommunity health service delivery through a functional community-health system can improve overall health systems strengthening and lead to improved community health. Policy-makers should integrate community health service delivery in all program implementation and ultimately work with the community health system as a veritable platform for effective community health service delivery.

Toward Malaria Elimination: Understanding Awareness, Prevention, and Health-Seeking Patterns in Odisha, India.

Given India's goal of eliminating malaria by 2030, this study aimed to investigate community perspectives on malaria in highly endemic areas of Odisha, a region historically prone to malaria. The research explores self-reported malaria events, community knowledge, attitudes, practices, health-seeking behaviors, and access to healthcare services. A community-based cross-sectional survey conducted among 387 households between November 2022 and May 2023 served as an extension of our recent project, monitoring malaria elimination efforts in remote and challenging-to-reach communities in Odisha. The participants, who had a mean (SD) age of 41.7 (13.17) years, were predominantly male (88.4%). Self-reported malaria in the last 12 months prior to the survey was 6.2%, with half of the patients opting for primary health centers for treatment, averaging a 5-day recovery per episode. The median cost per malaria treatment episode was U.S. dollars 20.17. A significant majority (79.8%) demonstrated a strong awareness of malaria symptoms and transmission, with 83.3% expressing a favorable attitude toward disease prevention. Notably, 65.1% reported consistent use of long-lasting insecticidal nets. However, nearly half of the participants reported inadequate larval source management and indoor residual spraying services. Although there were slight variations in knowledge, attitude, and practice scores among demographic groups, the overall understanding of and approach to malaria were consistent in the study population, with no statistically significant differences (P >0.05). The study findings offer hope, suggesting that with sustained dedication and focused surveillance, malaria could become a thing of the past.

Explanatory models and animal health-seeking behavior for East Coast fever in rural Kenya: an ethnographic study.

Explanatory models of disease focus on individuals' and groups' understandings of diseases, revealing a disconnect between livestock keepers and animal health providers. Animal health providers rely on models grounded in their veterinary training and experience. At the same time, livestock keepers may construct models based on traditional knowledge and their lived experience with East Coast fever in their cattle herds. To better understand East Coast fever and develop more efficient management strategies, this ethnographic study used the explanatory models' framework to provide a structured way for comprehending and contrasting different beliefs and understandings of East Coast fever as perceived by the livestock keepers across the different livestock production systems. Multiple data collection methods were employed, including unstructured observations, 30 in-depth interviews (IDIs), 18 focus group discussions (FGDs), and 25 key informant interviews (KIIs). Adult cattle, calves and sheep were perceived as susceptible to East Coast fever. However, there were varying perceptions of livestock susceptible to East Coast fever in the different livestock production systems. East Coast fever was attributed to multiple factors, including ticks, tsetse flies, mosquitos, birds, stagnant, dirty, or contaminated water, and livestock-wildlife interactions. However, some aspects were specific to the production system. Livestock keepers classified diseases based on observable signs, grouping diseases with similar signs under the same classification. Moreover, livestock keepers described different forms of East Coast fever ranging from treatable to fatal, which could be distinguished by the signs they presented. Self-treatment with drugs from the local agro-vet shops was the initial course of action during suspected cases of East Coast fever. Animal health practitioners were the last resort if self-treatment did not produce the desired outcome. Livestock keepers perceived avoidance of stagnant or contaminated water, tick control, and fencing as effective control measures for East Coast fever in their livestock herd. Very few livestock keepers were aware of an East Coast fever vaccine. Mechanistic explanations hold little significance in controlling East Coast fever. Instead, understanding and addressing livestock keepers' beliefs regarding ECF is crucial for promoting behaviors that support interventions across different livestock production systems.