Poor Health-seeking Behavior Research Articles

Cancer as a death sentence: developing an initial program theory for an IVR intervention.

To address current trends in poor health-seeking behaviour and late cancer diagnosis in many low- and middle-income countries, like Uganda, it is important to explore innovative awareness building interventions. One possible intervention is a common digital format, an interactive voice response (IVR) system, which is suitable for individuals with low technological and reading literacy. It is increasingly acknowledged that developing digital interventions requires co-creation with relevant stakeholders and explication of program developers’ assumptions, to make them effective, sustainable, and scalable. To this end, we sought to develop an initial program theory for a co-created IVR system for cancer awareness in Uganda. Utilising principles of the realist approach, a qualitative exploratory study was conducted through seven focus group discussions (FGDs) with people living with cancer (PLWC), health workers, and policy makers. Thematic analysis of the transcripts resulted in the emergence of four major themes. Through all themes the most consistent finding was that myths, misconceptions, and misinformation about cancer were related to every aspect of the cancer journey and influenced the experiences and lives of PLWC and their caregivers. Participants were positive about the potential of an IVR system but also had reservations about the design and reach of the system. The resulting initial program theory proposes that a context-specific IVR system has the potential to improve awareness on cancer, provided attention is given to aspects such as language, message framing, and accuracy.

Systematic review of changed smoking behaviour, smoking cessation and psychological states of smokers according to cigarette type during the COVID-19 pandemic.

ObjectivesAlthough the global COVID-19 pandemic has increased interest in research involving high-risk smokers, studies examining changed smoking behaviours, cessation intentions and associated psychological states among smokers are still scarce. This study aimed to systematically review the literature related to this subject.DesignA systematic review of published articles on cigarettes and COVID-19-related topicsData sourcesOur search was conducted in January 2021. We used the keywords COVID-19, cigarettes, electronic cigarettes (e-cigarettes) and psychological factors in PubMed and ScienceDirect and found papers published between January and December 2020.Data selectionWe included articles in full text, written in English, and that surveyed adults. The topics included smoking behaviour, smoking cessation, psychological state of smokers and COVID-19-related topics.Data extraction and synthesisPapers of low quality, based on quality assessment, were excluded. Thirteen papers were related to smoking behaviour, nine papers were related to smoking cessation and four papers were related to psychological states of smokers.ResultsOwing to the COVID-19 lockdown, cigarette users were habituated to purchasing large quantities of cigarettes in advance. Additionally, cigarette-only users increased their attempts and willingness to quit smoking, compared with e-cigarette-only users.ConclusionsOwing to the COVID-19 outbreak, the intention to quit smoking was different among smokers, according to cigarette type (cigarette-only users, e-cigarette-only users and dual users). With the ongoing COVID-19 pandemic, policies and campaigns to increase smoking cessation intentions and attempts to quit smoking among smokers at high risk of COVID-19 should be implemented. Additionally, e-cigarette-only users with poor health-seeking behaviour require interventions to increase the intention to quit smoking.

Pattern of infertility among infertile couples in a tertiary health institution in Bayelsa State, South-South Nigeria

<p class="abstract"><strong>Background:</strong> Infertility is a socially distressing medical condition that remains a public health concern in many developing countries, including Nigeria. The objective of the study was to evaluate the pattern of infertility among infertile couples in a tertiary hospital in South-South Nigeria.</p><p class="abstract"><strong>Methods:</strong> A retrospective, descriptive, cross-sectional study of infertile couples evaluated at the Infertility Clinic of the Federal Medical Centre, Yenagoa, Bayelsa State, South-South Nigeria, between January and December, 2021, was conducted. Case records of all the infertile couples evaluated during the study period were retrieved, and relevant data were extracted from the case records using a pre-designed proforma. Data obtained was analysed using Statistical Product and Service Solutions for Windows® version 25 (SPSS Inc.; Chicago, USA).</p><p class="abstract"><strong>Results: </strong>The incidence rate of infertility was 18.2%. Tubal factor was the most common (104, 55.6%) cause of infertility, with tubal blockage being the commonest (92, 49.2%) tubal pathology. Male factor was implicated in 81, 43.3%, of the cases, a combination of male and female factors in 45, 24.1%, while 5, 2.7%, of the cases were unexplained. Female factor alone was responsible for infertility in 101, 54.0%, of the cases, while male factor alone was identified in 36, 19.2%, of the cases.</p><p class="abstract"><strong>Conclusions:</strong> Our study’s incidence rate for infertility was similar to those reported in other studies in our region. To reduce the incidence of infertility, social reorientation to improve sociocultural practices and poor health-seeking behaviour of couples, should be pursued vigorously.</p><p> </p>

Health systems strengthening interventions for perinatal common mental disorders and experiences of domestic violence in Cape Town, South Africa: protocol for a pilot implementation study

BackgroundDuring the perinatal period, common mental disorders (CMDs) such as depression and anxiety are highly prevalent, especially in low-resource settings, and are associated with domestic violence, poverty, and food insecurity. Perinatal CMDs have been associated with several adverse maternal and child outcomes. While the Department of Health in South Africa provides healthcare workers with the tools to detect psychological distress and experiences of domestic violence, few healthcare workers routinely screen pregnant women at clinic visits, citing discomfort with mental health issues and the lack of standardised referral pathways as the key barriers. The aim of this study is to select and evaluate a set of health systems strengthening (HSS) interventions aimed at improving the care and outcomes for perinatal women with CMDs and experiences of domestic violence, attending public healthcare facilities in Cape Town.MethodsThis study consists of a pre-implementation, development, and implementation phase. Contextual barriers identified during the pre-implementation phase included poor patient knowledge and health-seeking behaviour, high levels of stigma, and poor detection, referral, and treatment rates. Implementation science determinant frameworks were applied to findings from the pre-implementation phase to identify determinants and gaps in delivering high-quality evidence-informed care. A participatory Theory of Change workshop was used to design a HSS programme, consisting of awareness raising, detection, referral, and treatment. HSS interventions selected to support the delivery of the HSS programme includes training, health promotion, change to the healthcare environment, task-sharing, audit and feedback, and performance monitoring. The implementation phase will be used to assess several implementation and clinical outcomes associated with the delivery of the HSS programme, which will be piloted at three healthcare facilities. Qualitative and quantitative methods will be used to evaluate the implementation and clinical outcomes.DiscussionThis pilot implementation study will inform us about a range of implementation and clinical outcome measures that are relevant for assessing HSS interventions for perinatal women with depression, anxiety, or experiences of domestic violence in low-resource settings. Lessons learnt from the pilot study will be incorporated into the design of a cluster randomised control trial for which further funding will be sought.

A report of measles outbreak investigations conducted in two rural communities in a state in southwest Nigeria, 2021

Background: Despite the availability of an effective vaccine, measles outbreaks continue to occur. According to the World Health Organization (WHO), a confirmed outbreak of measles is defined as if any 3 or more of blood specimens collected from a local government area (LGA) and within one month, having reached the laboratory in good condition, is IgM positive. This paper describes the outbreak investigation in two rural communities in a southwestern state in Nigeria.Methods: This was a descriptive cross-sectional study design. The outbreak investigation was conducted by a team of multi-disciplinary experts. Detailed case investigation of index cases, active case finding, vaccination coverage surveys and social mobilization activities were carried out. Descriptive analysis was using Microsoft excel and quantum geographic information system (GIS) was used to represent cases geographically.Results: A total of 42 measles cases were detected based on the WHO measles case definition. Blood samples were collected from 12 of the suspected cases for IgM determination, out of which 7 cases were IgM+. Majority of cases were <5 years old. Sixty-nine percent of the cases had received Measles vaccine. Socio-cultural and traditional beliefs were not unconnected to the poor uptake of vaccination.Conclusions: We confirmed the occurrence of measles outbreaks in Akotogbo and Ala-Elefosu communities, in Ondo State. Both communities had suboptimal measles vaccination coverages, highlighting the need to strengthen routine immunization (RI) services but also immediately addressing the sociocultural factors responsible for poor health seeking behavior and utilization of RI and primary health care (PHC) services.

Diagnostics Literacy Advocacy Model for Vulnerable Populations

Evidence shows that vulnerable populations have lower levels of health literacy, resulting in poor health-seeking behavior and poor uptake of diagnostics. Being health literate promotes health care-seeking behavior and improves engagement with diagnostic services. In this editorial, I define health literacy in the context of access to technology for enabling disease screening, diagnosis and linkage to care. I refer to health literacy in this context as diagnostics literacy. The COVID-19 pandemic has taught us that vulnerable populations are disproportionately disadvantaged by the disruptive measures put in place to control the spread of the virus. Many vulnerable populations are still experiencing short-and longer-term socio-economic consequences. I propose a multi-level diagnostics literacy advocacy model to help improve diagnostic uptake among vulnerable populations.

Health seeking behaviour and its socio-demographic determinants among menopausal women in Lucknow

Background: Menopausal women are those who have not experienced regular menstrual bleeding for 12 months or more. It is a physiological event, but its psychological, physical and sexual consequences will prevail throughout post-reproductive years. Some women are silently suffering without knowing what is happening to their own body and they don’t know about where to get help. Aim of the study was to estimate the health seeking behaviour among menopausal women in Lucknow and to find the association of Health Seeking behaviour among menopausal women with the various socio-demographic parameters.Methods: A community based cross sectional study was conducted from August 2020 to January 2021, among 206 Menopausal women of 46-65 years in rural and urban field practice areas of Community Medicine Department, KGMU, Uttar Pradesh, Lucknow.Results: (42.7%) of the total study participants went to the health facility for menopause related symptoms. (14.6%) had heard about HRT and (1%) were current user of HRT. (43%) responded that they will be fine with time, (29%) responded that they didn’t need to go to the health facility, (21.8%) had financial constrains. Literacy, residential status and category was found significantly associated with health seeking behaviour among menopausal women.Conclusions: Poor health seeking behaviour was observed among women for menopausal symptoms. Majority of them responded that they will be fine with time, other common reason for not going to health facility was that they were not aware about menopausal symptoms, they think that they don’t need to go to the health facility.

Socio-Cultural Perception, Attitude and Behavior That Affects Malnutrition Incidence among Children in Maiduguri, Borno State, Nigeria

The incidence of malnutrition in Maiduguri came under global observation in 2015. It had been on the gradual decline prior to the year 2018 as reported by the United Nations in 2017. There has been an alarming resurgence of malnutrition cases within the year, 2018. This study is aimed at explaining the relationship between the resurgence in the incidence of Malnutrition within Maiduguri and the strong sociocultural practices among the indigent people within Maiduguri. It was found out that 54.67% of the 150 randomly selected respondents agreed to have had their Children being placed on RUTF by medical personnel. It also noted that about 54% of the entire respondents had no idea of the importance of the RUTF being prescribed for their children. About 39% of the entire sample population preferred the complementary feeding type to other feeding types. 56% of the respondents had their deliveries conducted at home while only 38% had theirs in the hospital. It is relevant to note that wrong health practices like wrong feeding practices, child marriages and poor health-seeking behaviors are one of the main drivers of malnutrition in our society. One of the most effective means of reducing the incidence of malnutrition is by tackling poverty and encouraging education of children irrespective of their gender or physical challenge.

Prevalence and Socio-Demographic Determinants of Unintended Pregnancy among Women Attending Antenatal Clinic in Thyolo District, Malawi

Background: Unintended pregnancies remain a public health problem. Unintended pregnancies continue to be a leading predisposing factor to the high total fertility rate, high maternal and child health morbidity and mortality. Unintended pregnancies lead to unsafe abortion and poor health-seeking behavior, especially among young and poor women. Knowledge of associated factors can help to design and implement appropriate interventions. Objectives: This study aimed to determine the prevalence and socio-demographic factors associated with unintended pregnancy among women attending antenatal clinic (ANC) at Thyolo District Hospital in Malawi. Methodology: It was a quantitative cross-sectional study. Data was collected through face-to-face interviews with 396 women using a questionnaire. Systematic random sampling was used to recruit study participants. STATA version 13 package was used for univariate descriptive statistics, and logistic regression for bivariate and multivariate data analysis. Results: Slightly over half (54%) of women attending the antenatal clinic at Thyolo District Hospital had an unintended pregnancy. Unintended pregnancy was more likely to be reported among women of less than 20 years, education below secondary school level, marriage before 20 years, and polygamous relationships. In addition, families relying on farming alone other than employment or business were more likely to have an unintended pregnancy. Primgravidity and having no living child were also significantly associated with unintended pregnancy. Conclusion: Prevalence of unintended pregnancy is a health burden in Thyolo. Strategies to keep the girl child in school and delay marriage could address this challenge. Increasing access to effective contraceptive methods for the youth could mitigate the problem.

Potentially harmful medication use and the associated factors among pregnant women visiting antenatal care clinics in Mbarara regional referral hospital, southwestern Uganda

Pregnancy management using medications has been challenging for both healthcare providers and pregnant women, given the fear of teratogenicity effects and the potential for fetal harm. In the developing world, poor health-seeking behavior of patients, delayed initiation of antenatal care (ANC), and low level of educational status of mothers could contribute to the issue of drug safety in pregnancy. The aim of the study was to determine the prevalence and factors associated with potentially harmful medication use in pregnancy. A cross-sectional study was conducted from April 1 to June 6, 2021, including 209 pregnant women on ANC follow-up at a referral hospital in Southwestern Uganda. The simple random sampling technique was employed to select study participants. Interviewer-administered questionnaires were used to collect the history of medication use since conception and then the participant's ANC card was reviewed to determine prescribed drug regimens and their indications. Statistical Package for the Social Sciences version 23.0 was used for analysis. Out of the 1,422 medications used by 209 women, 665 (42.2%) were category C, and 182 (11.5%) were category A. A total of 92 (44.0%) pregnant women used at least one potentially harmful medication during the current pregnancy. Having more than average monthly income (adjusted odds ratio [aOR] = 2.32 [1.04, 5.14 at 95% confidence interval (CI)]), having a chronic disease (aOR = 3.24 [1.17, 8.97 at 95% C.I]), using 7 and more medications (aOR = 9.12 [4.11, 20.24 at 95% CI]), and use of herbal medicines (aOR = 4.50 [2.10, 9.87 at 95% CI]) were shown to be risk factors. The proportion of pregnant women that used at least one potentially harmful medication is higher than in previous studies. Having comorbidities and taking more medications increase the risk of receiving a potentially harmful medication during pregnancy. This study identified the gaps in the use of medicines during pregnancy which will enable the development and implementation of protocols for optimizing prescribing practices in pregnant women by focusing on the safety of the fetus.

A Cross Sectional Survey of Factors Influencing Healthcare Access in Older Women of South India

We examined the determinants of healthcare access barriers, treatment-seeking, and self-medication in older women aged 60 years and more, using a cross-sectional survey design. Using a structured interview format, we interviewed 1005 older women from 7 out of 14 districts in the state through a stratified random sampling procedure. Multiple linear regression analysis results reveal that older women's healthcare access barriers significantly increased when they experienced a long duration of multimorbidity alongside poor recognition of autonomy and basic amenities available at health facilities. However, confidentiality, the ability to pay for healthcare expenditure, and the type of health care significantly improved healthcare access. In factors influencing older women's delay in treatment-seeking, optimal instrumental functionality in daily living, optimal quality of life and access to healthcare services significantly reduced delay in treatment initiation. Whereas poor health-seeking behaviors, long duration of multimorbidity, and the quality of basic amenities at hospitals significantly increased treatment initiation delay and explained 13.6% of the variance. In factors influencing older women's use of self-medication, advancing age, living in rural areas, optimal functionality, perception of providers' respect for confidentiality were associated with increased self-medication frequency. Whereas, better wealth status, prompt attention to older women's health needs, and basic amenities at hospitals significantly reduced their self-medication practice. Therefore, the optimal functional abilities, fewer morbidities, and optimal health system responsiveness significantly reduce healthcare access barriers and self-medication while improving older women's treatment-seeking behaviors.

Assessment of Factors Associated with Low Measles Vaccine Effectiveness in Honkolo-Wabe District, Ethiopia

Background:-Measles is an acute illness and the most contagious childhood diseases. Almost all non-immune children contract this respiratory disease if exposed to the virus. The disease characterized by prodarmal fever, conjunctivitis, coryza and presence of Koplik spots. Prior to the introduction of vaccination programs, measles affected almost every child in the world. The expected sero conversion was estimated to 80-85% when 0.5ml live attenuated measles vaccine correctly administered subcutaneously at 9 months and more than 95% after 12months. This study was aimed to describe vaccine effectiveness and assess factors contributing to low measles vaccine effectiveness in Honkolo-Wabe district, Ethiopia. Methods:-Community based unmatched case-control study, involving 51 children who had previous measles illness were randomly selected and 153 controls were selected from the community three for each case in July, 2014. Vaccination status and other risk factors for the study children were ascertained through by interviewing mothers /care giver and observing the cold chain management. Epi-info version 7 was used for data analysis. Results:-Measles vaccine effectiveness was estimated at 70.9% [95% CI=65-79%]. Age of measles vaccine given, poor health seeking behavior of the community, number of dose and inappropriate vaccine transportation from district health office to health post, administration of reconstituted vaccine after 6hrs by HEW were identified as the contributing factors for low measles vaccine effectiveness in Honkolo-Wabe district. Contacting with laboratory confirmed or epidemiological linked measles cases statically significant regard to measles [OR=23.77, 95% CI=9.17-64.25]. Of the study participants 19.6%, 44.6% and 3.9% were received one, two and three doses of measles vaccine respectively. About 3.9%, 45.1% and 12.3% of the participants were received first dose of measles vaccination before, at 9month and after nine month respectively. However 18.6% of the study participants were not received 2nd does. Only 35.3% of the participants were received their second doses after 12month their birth. Conclusions:-Measles vaccine effectiveness was low. Age of children, number of dose, inappropriate vaccine transportation and utilization of reconstituted vaccine after 6hrs were contributing factors for low measles vaccine effectiveness. Regular monitoring and ensure of all birth cohort have received at least 2 doses of measles vaccine at 9month of their birth and above. Improve cold chain management at health post and use reconstituted vaccine within 6 hours.

Assessment of urogenital schistosomiasis among basic school children in selected communities along major rivers in the central region of Ghana.

Introductionurogenital schistosomiasis affects school-aged children with impacts on health, growth, and cognitive development. Basic schools along active water bodies have a possibility of a high infection among the children.Methodswe performed a school-based cross-sectional assessment of urogenital schistosomiasis among children in four selected rural communities along major rivers in the central region of Ghana. Three hundred and nine (309) basic school children class 1 to junior high school (JHS) 3 were recruited. Sociodemographic data and information on behavioral influences were collected with a structured written questionnaire. Laboratory examinations were conducted on fresh urine samples. Descriptive statistics and cross-tabulations with measures of association between variables, adjusted and unadjusted logistic regression analysis were performed on measured variables.Resultswe recorded a 10.4% prevalence of urogenital schistosomiasis. Schools in communities along the Kakum river recorded the highest disease burden (65.6%). The odds of infection among pupils who engage in irrigation activities were 4 folds more than those who do not engage in irrigation activities (adjusted odds ratio (aOR) (95%CI): 4.3 (1.6-12.1), P-value=0.005). Pupils of caregivers who resort to self-medication using local herbal concoctions had 14-fold more odds of infection compared to those who visit the health facility (aOR (95%CI): 14.4 (1.4-143.1), P-value=0.006).Conclusionpoor health-seeking behaviors and lack of access to health facilities influenced the disease proportion among the children in these endemic communities.

Urinary incontinence among Saudi women: prevalence, risk factors, and impact on quality of life.

This study was done to determine UI prevalence among women in Saudi Arabia and identify the associated risk factors. This cross-sectional study was conducted from January 2020 to September 2020 in Saudi women who came to the Urology Department at King Khalid Hospital, Majmaah, Saudi Arabia. In the age group of 20 to 50 years, Saudi women who are not seriously ill or pregnant or in the postnatal period or diagnosed with pelvic organ prolapse were included as participants. A semi-structured questionnaire modified from the International Consultation Incontinence Questionnaire-Short Form was used to collect data on frequency, the severity, consequences, and impact of UI on quality of life. Data were analyzed by SPSS 23 (IBM, Armonk, NY, USA) with the calculation of mean and standard deviation for quantitative variables. Logistic regression analyses were applied to determine the predictors of UI. A total of 451 participants were included in the final analysis. The mean age of the study population was 42.52 years (SD 11.75). Among risk factors, 45 (10%) had diabetes, 56 (12.4%) had hypertension, 36 (8%) had asthma, 80 (17.7%) had UTI/STDs. Out of 451 participants, 188 (41.7%) had urinary incontinence (UI). Sociodemographic characteristics and risk factors like family income, urinary and genital infections (UTI/STDs), pelvic/uterine prolapse, any other disease, and cough were found to have a statistically significant association with urinary incontinence (p-value <0.05). The prevalence of UI was 41.7% among the study population. The various risk factors associated with UI are older age, parity, multiple vaginal deliveries, hypertension, history of asthma, and chronic cough. Poor health-seeking behavior was observed. Creating awareness and the need for early diagnosis with timely intervention is recommended.

Factors Associated with Distribution of Pre-Eclampsia and Eclampsia Among Rural and Urban Women in Child Bearing Age – A Case of Mbala General Hospital, Northern Province, Zambia

Preeclampsia and eclampsia cases continue to rise in northern Zambia as people search for babies and continuity of clans’ survival. Due to the competitive nature of cultural demands/ myths on pregnancy and maternal socio-demographic factors (low-age, low socio-economic status, and poor health-seeking behaviour), women in rural prefer unprofessional primary health care services that are presumably affordable to them thereby, delaying in seeking for professional healthcare services. High levels of poverty in resource-limited areas have put many female adolescents at risk of falling pregnant. Thus, this study probed on the interaction between these maternal socio-demographic factors and disease distribution in both rural and urban areas with respect to various pregnancy outcomes. The study used retrospective quantitative methods in eliciting information from data sources (women, registers) in Mbala, Mpulungu, Senga, and Mungwi districts covering 3-year period (2017-2019). In all, 202 female respondents from Northern Zambia were interviewed through self-administered questionnaires. Thereafter, data were analysed using a statistical package for the social sciences (SPSS v16). Findings indicate severe; socio-economic status and low maternal age affect pre-eclampsia disease distribution coupled with adverse pregnancy outcomes more in rural than urban areas. The better the socio-demographic conditions, the lower the disease distribution with good pregnancy outcomes. However, worsening maternal socio-demographic conditions may increase the incidence of pre-eclampsia among pregnant women of northern Zambia. The study recommended interventions tarred towards public health programmes such as social behaviour change and communication (SBCC) towards adolescent women and socio-economic empowerment of pregnant women in resource-limited areas. Keywords: Average ANC timing, Preeclampsia, Residency, Socio-economic, Teenage pregnancy.

Clinical perspective of myths about oral health in patients visiting tertiary hospital in eastern Nepal: A descriptive cross-sectional study

Background: Nepalese population consists of people from different cultural backgrounds having strong influence of the various myths on health seeking behaviour. Myths are defined as stories shared by a group of people which are a part of their cultural identity. They have a strong influence in the life of individuals and their way of living including seeking treatment during illness. Objectives: The objective of this study was to assess the prevalence of myths related to oral health. Methods: A descriptive cross-sectional study was conducted in Nobel Medical College and Teaching hospital after obtaining ethical clearance from January 2021 to March 2021 using convenience sampling technique. Patients above 15 years visiting dental OPD were included and refused to participate were excluded. SPSS Statistics for Windows, version 21.0 was used for statistical analysis. Results: There were total 250 participants: 103 (41.2%) male and 147 (58.8%) female with mean age 34.43 ± 10.75 years and ranging from 18 to 62 years. Among the participants, 178 (72.1%) regarded fomentation of swelling with hot water while 72 (21.9%) were against it. Among all the participants 36 (14.4%) supported that there was presence of worm in decayed tooth whereas 214 (85.6%) were against it. Conclusion: The prevalence of myths about dentistry was high among study population which could be associated with poor early health seeking behaviour and poor compliance with treatment.

Access to Healthcare and Health Seeking Behaviour among Female Head Porters in Kumasi, Ghana: The Impact on Public Health

Given the nodality of Kumasi, the city attracts migrants from all parts of Ghana into its market space. Notable among such migrants are the female head porters popularly called “Kayayie”. As a result of the expensive rents in urban space, female head porters live in kiosks, verandas, and squatters in any available space. This exposes the porters to a myriad of environmental and health risks amidst poor health-seeking behaviour. This study sought to examine access to health and health-seeking behaviour of female head porters in Kumasi. The study adopted quantitative methods in collecting and analyzing data. The primary units of the investigation were female head porters. The study used a sample size of 250 respondents who were interviewed through self-administered questionnaires. Findings show that only 25.2% of the respondents had access to healthcare, as about 74.8% lacked access to basic healthcare. The majority of those who had access to healthcare (54%) go to the health facility by foot, while about 42.9% access the facility by car. Though 71.4% of the head porters were subscribers of NHIS, only 25.2% resort to professional healthcare givers when they are sick. Generally, access to health and health-seeking was poor among the female head porters. The study recommended the expansion of health facilities, especially in poor urban communities, and education on health-seeking among head porters. Keywords: Female head porters, Health seeking behaviour, Health conditions, Migration; Urban poor.

738Health Status and Quality of Life of Indigenous Elderly Population of Bangladesh

Abstract Background Indigenous people, although constitute 1.8% of the country’s population, are one of the most deprived communities of Bangladesh in all sectors. This study was conducted to explore the health status and quality of life of indigenous elderly of Bangladesh as there is scarcity of knowledge regarding this. Methods A mixed-method approach was deployed on October,2019 in Sylhet-division of Bangladesh. A cross-sectional survey was conducted among 400 indigenous elderlies from 8 tea-gardens and ten in-depth-interviews were conducted with health-service providers of tea-garden health-facilities. Results Of the indigenous elderly-respondents, majority (79.5%) were suffering from any kind of chronic diseases. Visual difficulty was found predominant (74%) among the chronic conditions, followed by locomotion difficulty (49%) and gastrointestinal problem (41%). Extreme age, being male, living alone and low family income were significantly associated with suffering from chronic conditions. Furthermore, having chronic condition and extreme-age was found to be significantly associated with low quality of life. Health-service providers identified lack of logistical support in health-facilities, economic crisis and lack of awareness as the causes of poor health-status and health-seeking behavior of the indigenous elderly. Conclusions Indigenous older men in extreme old age are more vulnerable to adverse health conditions and poor quality of life. Health literacy and health seeking behaviour is poor among indigenous older adults generally and there is a huge gap in the health services and social supports available to them. Key messages Indigenous, Older population, Bangladesh.

Health-seeking behaviour among pregnant women during the COVID-19 pandemic: A qualitative study

BackgroundThe novel coronavirus pandemic has killed millions of people globally while significantly destroying the social, economic, and political wellbeing of people. The global pandemic has negatively impacted pregnant women's access to prenatal care. The current study sought to understand the health-seeking behaviour of women who were pregnant during the onset of the COVID-19 pandemic in Kenya. MethodsThe “Three Delay” model theoretical framework was applied to piece together the pregnant women's health-seeking behaviour during the early stages of the pandemic through focus group discussions. The collected qualitative data was analysed using thematic analysis. ResultsThe delays in deciding to seek care, delays in reaching healthcare facilities and delays in receiving quality healthcare services at the healthcare facility were a result of the fear of contracting the virus. These delays were occasioned by participants’ personal experiences and uncertainties about COVID-19 pandemic, compulsory quarantines, national cessation of movements, compulsory lockdowns, loss of income to many households and the influence of traditional birth attendants (TBAs). ConclusionThe current study found that fear of COVID-19 was a major factor that hindered access to maternal healthcare services. In this regard, there is a need to upscale awareness creation on the significance of seeking maternal health services during the pandemic to reduce the possibility of obliterating the gains made in reducing poor health-seeking behaviours among pregnant women.

Health systems, population and patient challenges for achieving universal health coverage for hypertension in Ghana.

Ghana has signed on to the United Nations Sustainable Development Goal to achieve universal health coverage (UHC), ensuring that all individuals receive the health care they require without financial hardship. Achieving that goal is a difficult task in any setting. The challenges are further exacerbated by a changing disease landscape, as the burden of non-communicable diseases (NCDs) is increasing and creating a dual burden along with infectious diseases. This study explores the existing health system for delivering hypertension care and the challenges of delivering UHC for hypertension in Ghana. Document analysis of national health reports, policies and legislations along with a review of research articles was conducted to explore the challenges of delivering UHC for NCDs in Ghana, and hypertension in particular. The main themes and indicators related to the challenges of delivering UHC for hypertension were mapped and analysed. The main challenges to delivering UHC for hypertension can be grouped into population and patient, on the one hand, and health system factors, on the other. Population and patient factors include (1) unhealthy lifestyles overburdening the health system, (2) poor health-seeking behaviour and (3) poor adherence to medication, which has led to uncontrolled cases and poor clinical outcomes even among treated patients with hypertension. Health system factors include (1) inadequate health system capacity for early diagnosis due to an increasing number of patients, (2) inequitable distribution of health care facilities affecting access, (3) financial sustainability of the National Health Insurance Scheme and delays in reimbursement of claims to facilities that affect the health system's ability to provide timely management of hypertension and (4) health care facilities and practitioners' use of non-standardized and uncalibrated blood pressure measuring equipment. Ghana therefore will need to make important decisions to overcome operational and financial challenges on its path to UHC.