scholarly journals The Use of Respondent-Driven Sampling To Assess Febrile Illness Treatment-Seeking Behaviors Among Forest Goers in Cambodia and Vietnam

2021 ◽  
Author(s):  
Mahesh Paudel ◽  
Kemi Tesfazghi ◽  
Hoa Nguyen ◽  
Sochea Phok ◽  
Shwetha Sriniva ◽  
...  
Keyword(s):  
Private Sector ◽  
Malaria Elimination ◽  
Febrile Illness ◽  
Diagnosis And Treatment ◽  
Treatment Seeking ◽  
Respondent Driven Sampling ◽  
Public Facility ◽  
Health Seeking ◽  
Health Seeking Behaviors ◽  
Study Results

Abstract Background Countries in the Greater Mekong Subregion (GMS) aim to eliminate all forms of malaria by 2030. In Cambodia and Vietnam Forest goers are at highest risk of malaria. Universal access to prompt diagnosis and treatment is a core malaria intervention. This can only be achieved by understanding the health seeking behaviors among the most vulnerable groups and eliminating the barriers to prompt and effective treatment. This study aimed to improve understanding by exploring health seeking behaviors for febrile illness among populations at risk for malaria in Cambodia and Vietnam. Methods In 2019, researchers from Population Services International (PSI) conducted a population-based survey of forest goers in Cambodia and Vietnam using respondent-driven sampling (RDS). In Cambodia two operational districts, Oral and Phnom Srouch, in Kampong Speu Province were included in the study. In Vietnam, communes located within 15 km of the forest edge in Binh Phuoc and Gia Lai provinces were selected. Adults who had spent at least one night per week or four nights per month in the forest over the past three months were considered potential participants for the study. Results 75% in Cambodia and 65% in Viet Nam of forest goers sought treatment outside the home for illness. In Cambodia 39% sought treatment from the private sector, 32%, from community health workers and 24% from public health facilities. In Vietnam, 62% sought care from community facilities, 29.3% from the private sector and 6.9% went to a public facility. Amongst forest goers who sought care, 33% in Cambodia and 52% in Vietnam did so within 24 hours. Conclusions This study is consistent with others that show that early diagnosis and treatment of malaria remains an obstacle to malaria elimination. This study also demonstrates that there are gaps in timeliness of care seeking amongst forest goers. The findings from this study around provider preference and delays in treatment seeking behaviors can be utilized to strengthen the design and targeting of malaria interventions and social behavior change strategies in order to accelerate malaria elimination in Cambodia and Vietnam.

scholarly journals The use of respondent‑driven sampling to assess febrile illness treatment-seeking behaviours among forest-goers in Cambodia and Vietnam

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Mahesh Paudel ◽  
Kemi Tesfazghi ◽  
Hoa Nguyen ◽  
Sochea Phok ◽  
Shwetha Srinivasan ◽  
...  
Keyword(s):  
Private Sector ◽  
Malaria Elimination ◽  
Febrile Illness ◽  
Diagnosis And Treatment ◽  
Treatment Seeking ◽  
Respondent Driven Sampling ◽  
Public Facility ◽  
Healthcare Seeking ◽  
Populations At Risk ◽  
Increased Risk

Abstract Background Countries in the Greater Mekong sub-region (GMS) aim to eliminate all forms of malaria by 2030. In Cambodia and Vietnam, forest-goers are at an increased risk of malaria. Universal access to prompt diagnosis and treatment is a core malaria intervention. This can only be achieved by understanding the healthcare-seeking behaviour among the most vulnerable groups and eliminating barriers to prompt and effective treatment. This study aimed to explore healthcare-seeking behaviours for febrile illness among populations at risk for malaria in Cambodia and Vietnam. Methods In 2019, researchers from Population Services International (PSI) conducted a population-based survey of forest-goers in Cambodia and Vietnam using respondent-driven sampling (RDS) In Cambodia two operational districts, Oral and Phnom Srouch in Kampong Speu Province were included in the study. In Vietnam, communes located within 15 km of the forest edge in Binh Phuoc and Gia Lai Provinces were selected. Adults who had spent at least one night per week or four nights per month in the forest over the previous three months were eligible for the study. Results Some 75% of forest-goers in Cambodia and 65% in Vietnam sought treatment for illness outside the home. In Cambodia, 39% sought treatment from the private sector, 32% from community health workers, and 24% from public health facilities. In Vietnam, 62% sought care from community facilities, 29.3% from the private sector, and 6.9% went to a public facility. Among forest-goers who sought care, 33% in Cambodia and 52% in Vietnam did so within 24 h. Conclusions This study is consistent with others that show that early diagnosis and treatment of malaria remains an obstacle to malaria elimination. This study also demonstrates that there are gaps in timeliness of care seeking among forest-goers. The findings from this study around provider preference and delays in treatment-seeking can be used to strengthen the design and targeting of malaria interventions and social and behaviour change strategies to accelerate malaria elimination in Cambodia and Vietnam.

scholarly journals In Search of the Last Malaria Cases: Ethnographic Methods for Community and Private-sector Engagement in Malaria Elimination in Vietnam, Laos, and Cambodia

2021 ◽  
Author(s):  
Yoriko Masunaga ◽  
Joan Muela Ribera ◽  
Thuan Thi Nguyen ◽  
Kemi Tesfazghi ◽  
Koen Peeters Grietens
Keyword(s):  
Private Sector ◽  
Malaria Elimination ◽  
Participant Observation ◽  
Malaria Diagnosis ◽  
Health Seeking ◽  
Community Members ◽  
Migrant Populations ◽  
Forested Areas ◽  
Hard To Reach Populations ◽  
Private Sector Engagement

Abstract Background Despite significant strides made in reducing malaria morbidity and mortality in the Greater Mekong Subregion, malaria transmission continues amongst the most ‘hard-to-reach’ such as forest-goers and mobile and migrant populations, who face access obstacles to malaria diagnosis and treatment. As such, regional malaria elimination strategies endeavour to incorporate the private sector and local communities in improving surveillance and detection of the last malaria cases in remote forested areas. The question remains, however, whether such strategies can reach these hard-to-reach populations and effectively reduce their disproportionate burden of malaria. This paper evaluates the strategy of community and private sector engagement in a malaria elimination project in Vietnam, Laos, and Cambodia.Methods Ethnographic research, incorporating in-depth interviews, participant observation with informal discussions, and group discussions were conducted in Bu Gia Map commune, Binh Phuc province of Vietnam; in Phouvong district, Attapeu province of Laos; and, in nine newly established and informal communities in the provinces of Mondul Kiri, Steung Treng, Kratie, Kampong Thom, and Prah Vihear of Cambodia. Results Different types of factors limited or enhanced the effectiveness of the participatory approaches in the different settings. In Vietnam, inter-ethnic tensions and sensitivity around forest-work negatively affected local population’s health seeking behaviour and consequent uptake of malaria testing and treatment. In Laos, the location of the project collaborative pharmacies in the district-centre were a mismatch for reaching hard-to-reach populations in remote villages. In Cambodia, the strategy of recruiting community malaria-workers, elected by the community members, did manage to reach the remote forested areas where people visited or stayed. Conclusions ‘Hard-to-reach’ populations remain hard to reach without proper research identifying the socio-economic-political environment and the key dynamics determining uptake in involved communities and populations. We emphasise the need for solid implementation research with a strong ethnographic component in order to tailor malaria elimination strategies to local contexts.

scholarly journals In search of the last malaria cases: ethnographic methods for community and private-sector engagement in malaria elimination in Vietnam, Laos, and Cambodia

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Yoriko Masunaga ◽  
Joan Muela Ribera ◽  
Thuan Thi Nguyen ◽  
Kemi Tesfazghi ◽  
Koen Peeters Grietens
Keyword(s):  
Private Sector ◽  
Malaria Elimination ◽  
Malaria Diagnosis ◽  
Health Seeking ◽  
Community Members ◽  
Migrant Populations ◽  
Forested Areas ◽  
Hard To Reach Populations ◽  
Greater Mekong Subregion ◽  
Private Sector Engagement

Abstract Background Despite significant strides made in reducing malaria morbidity and mortality in the Greater Mekong Subregion, malaria transmission continues amongst the most ‘hard-to-reach’, such as forest-goers and mobile and migrant populations, who face access obstacles to malaria diagnosis and treatment. As such, regional malaria elimination strategies endeavour to incorporate the private sector and local communities in improving surveillance and detection of the last malaria cases in remote forested areas. The question remains, however, whether such strategies can reach these hard-to-reach populations and effectively reduce their disproportionate burden of malaria. This paper evaluates the strategy of community and private sector engagement in a malaria elimination project in Vietnam, Laos, and Cambodia. Methods Ethnographic research, incorporating in-depth interviews, participant observations with informal discussions, and group discussions were conducted in Bu Gia Map commune, Binh Phuc province of Vietnam; in Phouvong district, Attapeu province of Laos; and, in nine newly established and informal communities in the provinces of Mondul Kiri, Steung Treng, Kratie, Kampong Thom, and Prah Vihear of Cambodia. Results Different types of factors limited or enhanced the effectiveness of the participatory approaches in the different settings. In Vietnam, inter-ethnic tensions and sensitivity around forest-work negatively affected local population’s health-seeking behaviour and consequent uptake of malaria testing and treatment. In Laos, the location of the project collaborative pharmacies in the district-centre were a mismatch for reaching hard-to-reach populations in remote villages. In Cambodia, the strategy of recruiting community malaria-workers, elected by the community members, did manage to reach the remote forested areas where people visited or stayed. Conclusions ‘Hard-to-reach’ populations remain hard to reach without proper research identifying the socio-economic-political environment and the key dynamics determining uptake in involved communities and populations. Solid implementation research with a strong ethnographic component is required to tailor malaria elimination strategies to local contexts.

scholarly journals Determinants of treatment-seeking behavior during self-reported febrile illness episodes using the socio-ecological model in Kilombero District, Tanzania

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Caroline M. Mburu ◽  
Salome A. Bukachi ◽  
Khamati Shilabukha ◽  
Kathrin H. Tokpa ◽  
Mangi Ezekiel ◽  
...  
Keyword(s):  
Health Care ◽  
Ecological Model ◽  
Febrile Illness ◽  
Sub Saharan Africa ◽  
Differential Diagnostics ◽  
Treatment Seeking ◽  
Zoonotic Infections ◽  
Appropriate Treatment ◽  
Seeking Behavior ◽  
Tract Infections

Abstract Background Febrile diseases in Sub-Saharan Africa cause acute and chronic illness. Co-infections are common and these diseases have a complex etiology that includes zoonoses. For the implementation of appropriate treatment and control strategies, determinants of lay treatment-seeking behavior by the affected communities need to be understood. The objective of this study was to explore, using the socio-ecological model, the determinants of treatment-seeking actions among self-identified febrile illness cases in the Kilombero District of Tanzania. Methods Thirty-nine in-depth interviews were conducted with 28 men and 11 women in three villages in Kilombero district. These villages were purposively selected due to malaria endemicity in the area, animal husbandry practices, and proximity to livestock-wildlife interaction, all risk factors for contracting febrile zoonotic infections. Thematic analysis was conducted on the interviews to identify the key determinants of treatment-seeking actions. Results Study participants attributed febrile illnesses to malaria, typhoid and urinary tract infections. Treatment-seeking behavior was an iterative process, influenced by individual, socio-cultural, ecological and policy factors. Age, expendable income, previous history with a febrile illness, perceptions on disease severity, seasonal livelihood activities and access to timely healthcare were some of the determinants. Self-treatment with pharmaceutical drugs and herbs was usually the initial course of action. Formal healthcare was sought only when self-treatment failed and traditional healers were consulted after the perceived failure of conventional treatment. Delays in seeking appropriate health care and the consultation of medically unqualified individuals was very common. Conclusion The results imply that treatment-seeking behavior is shaped by multiple factors across all levels of the socio-ecological model. Public policy efforts need to focus on facilitating prompt health care seeking through community education on the complicated etiology of febrile illnesses. Improved access to timely treatment and better differential diagnostics by health professionals are essential to ensure correct and appropriate treatment and to reduce reliance of patients on unqualified persons.

Low First Wave COVID-19 cases and health seeking behaviors across the six geopolitical zones of Nigeria

2021 ◽  
Vol 42 (1) ◽  
pp. 1-8
Author(s):  
C.N. Ukaga ◽  
S.O. Sam-Wobo ◽  
R.H. Muhammed ◽  
H.O. Mogaji ◽  
O.A. Surakat ◽  
...  
Keyword(s):  
Laboratory Testing ◽  
Management Strategies ◽  
Demographic Characteristics ◽  
Community Level ◽  
Health Seeking ◽  
Routine Testing ◽  
Home Management ◽  
Health Seeking Behaviors ◽  
Very High ◽  
Age Category

This study was carried out across the six geopolitical zones to assess knowledge and health seeking behaviors of Nigerians during the first wave of COVID-19 pandemic lockdown in order to understand the seemingly low cases of COVID-19 in Nigeria. Structured and pretested short questionnaires were employed to obtain information electronically and physically across the six geopolitical zones on socio-demographic characteristics of participants; the knowledge of participants on COVID-19 disease; availability and accessibility to testing and isolation centers in the communities, attitudes and health seeking behaviors. Atotal of 1023 respondents; 705 (68.9%) males and 318 (31.1%) females across the six geopolitical zones in Nigeria participated in this study with 477(46.6%) within the 26-45 years age category, and 6(0.6%) above 66 years. Atotal of 985(96.3%) had heard about COVID-19 at the time of survey while a total of  859(84.0%) of the respondents were aware of the presence of COVID-19 laboratory testing centers. Across the geopolitical zones, majority of the respondents 487(47.6%) claimed there are no routine testing for COVID-19 at their community level, while 303 (29.6%) affirmed otherwise and 216(21.1%) did not know if there were routine testing going on or not. On health seeking behaviors across the  country, majority of the respondents 558(54.5%) affirmed they would visit the hospital as the first point of contact if the opportunitypresented itself, 244(23.9%) claimed they would call the NCDC toll line, 2(0.2%) said they would use prayers, while 1(0.1%) respectively claimed they would use home management strategies through visiting chemist stores and checking the internet for solutions. Findings from this study confirm that there is very high awareness of the COVID-19 disease across the country, and limited number of testing centers at the community level. The implications include the possibility of unreported COVID19 cases in the cities as well as in the  communities. Keywords: COVID-19, knowledge, health seeking behaviors, community level 

scholarly journals Physician Self-disclosure of Lived Experience Improves Mental Health Attitudes Among Medical Students: A Randomized Study

2020 ◽  
Vol 7 ◽  
pp. 238212051988935 ◽  
Author(s):  
Andrés Martin ◽  
Julie Chilton ◽  
Doron Gothelf ◽  
Doron Amsalem
Keyword(s):  
Mental Health ◽  
Mental Illness ◽  
Medical Students ◽  
Help Seeking ◽  
Randomized Study ◽  
Role Modeling ◽  
Mental Illnesses ◽  
Control Group ◽  
Health Seeking ◽  
Health Seeking Behaviors

Introduction: Depression and suicidal ideation are common among medical students, a group at higher risk for suicide completion than their age-normed peers. Medical students have health-seeking behaviors that are not commensurate with their mental health needs, a discrepancy likely related to stigma and to limited role-modeling provided by physicians. Methods: We surveyed second-year medical students using the Attitudes to Psychiatry (ATP-30) and Attitudes to Mental Illness (AMI) instruments. In addition, we asked questions about role-modeling and help-seeking attitudes at baseline. We then conducted a randomized trial of an intervention consisting of 2 components: (a) a panel of 2 physicians with personal histories of mental illness speaking about their diagnosis, treatment, and recovery to the students, immediately followed by (b) small-group facilitated discussions. We repeated the ATP-30 and AMI after the active/early group was exposed to the panel, but before the control/late group was similarly exposed. Results: Forty-three medical students participated (53% women). The majority of students (91%) agreed that knowing physicians further along in their careers who struggled with mental health issues, got treatment, and were now doing well would make them more likely to access care if they needed it. Students in the active group (n = 22) had more favorable attitudes on ATP-30 ( P = .01) and AMI ( P = .02) scores, as compared with the control group (n = 21). Conclusion: Medical students can benefit from the availability of, and exposure to physicians with self-disclosed histories of having overcome mental illnesses. Such exposures can favorably improve stigmatized views about psychiatry, or of patients or colleagues affected by psychopathology. This intervention has the potential to enhance medical students’ mental health and their health-seeking behaviors.

scholarly journals Whether Public Hospital Reform Affects the Hospital Choices of Patients in Urban Areas: New Evidence from Smart Card Data

2021 ◽  
Vol 18 (15) ◽  
pp. 8037
Author(s):  
Fangye Du ◽  
Jiaoe Wang ◽  
Haitao Jin
Keyword(s):  
Smart Card ◽  
Public Hospital ◽  
Tertiary Hospital ◽  
Small Sample ◽  
Health Seeking ◽  
Spatiotemporal Resolution ◽  
Hospital Reform ◽  
Health Seeking Behaviors ◽  
Smart Card Data ◽  
Public Hospital Reform

The effects of public hospital reforms on spatial and temporal patterns of health-seeking behavior have received little attention due to small sample sizes and low spatiotemporal resolution of survey data. Without such information, however, health planners might be unable to adjust interventions in a timely manner, and they devise less-effective interventions. Recently, massive electronic trip records have been widely used to infer people’s health-seeking trips. With health-seeking trips inferred from smart card data, this paper mainly answers two questions: (i) how do public hospital reforms affect the hospital choices of patients? (ii) What are the spatial differences of the effects of public hospital reforms? To achieve these goals, tertiary hospital preferences, hospital bypass, and the efficiency of the health-seeking behaviors of patients, before and after Beijing’s public hospital reform in 2017, were compared. The results demonstrate that the effects of this reform on the hospital choices of patients were spatially different. In subdistricts with (or near) hospitals, the reform exerted the opposite impact on tertiary hospital preference compared with core and periphery areas. However, the reform had no significant effect on the tertiary hospital preference and hospital bypass in subdistricts without (or far away from) hospitals. Regarding the efficiency of the health-seeking behaviors of patients, the reform positively affected patient travel time, time of stay at hospitals, and arrival time. This study presents a time-efficient method to evaluate the effects of the recent public hospital reform in Beijing on a fine scale.

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