P. Falciparum Community Prevalence and Health Seeking Behaviors in Rural Sussundenga District, Mozambique

Background: The large-scale effectiveness of malaria control interventions is differential at international border settings with varying policies, such as that between Mozambique and Zimbabwe. Impacts of nationally directed malaria control interventions hinge on understanding malaria transmission and prevention at the community level along international borders. Thus far, few studies have focused on central Mozambique. Our aim was to describe community level P. falciparum transmission dynamics and health seeking behaviors among residents of Sussundenga, Mozambique, a rural village bordering Zimbabwe in Manica Province with high malaria incidence reported at the Sussundenga-Sede health center (RHC). Methods: We conducted a cross-sectional community-based survey from December 2019 – February 2020. We used a random household sampling method, based on enumerated households from satellite imagery. All consenting participants completed a survey about malaria risk, prevention, and health seeking-behaviors, and received a P. falciparum malaria rapid diagnostic test (RDT). Results: We enrolled 96 households with 358 individuals. The P. falciparum prevalence was 31.6% (95% CI [26.6-36.5]). Ninety-three percent of participants reported using the Sussundenga-Sede RHC for healthcare. Sixty-six percent of participants (N=233) experienced at least one malaria symptom in the past month, with self-reported fever most frequently reported (19.3%). Of these, 176 (76.5%) sought care in a health facility and 174 (79%) received an RDT with 130 (63%) positive results. Of those with a positive RDT, 127 (97%) received Coartem®. Following treatment, 123 (97%) participants' symptoms resolved within a median of 3 days (IQR: 3-5) ranging from 2-14 days. In this high transmission setting, a high proportion of participants recognized malaria related symptoms then received a proper diagnostic test and treatment in a health facility. Conclusions: Future interventions that leverage this health seeking behavior and strengthen health systems for community interventions will improve malaria control and inform the efficacy of potential interventions at this particular international border.

Maternal health care services in Nepal: A qualitative perspective based on the socio-ecological model

Nepal has a high Maternal Mortality Rates (MMR) in the South Asian region, partly due to the poor utilization of maternal and child healthcare services. The study aims to explore the influencing factors of maternal and child healthcare services among Nepalese women. Eighteen women, who had seven-days-old-children and those recently accessed maternal and child healthcare practices, were purposively selected. The face-to-face, In-depth-Interview (IDI) was applied to collect the information. The data were thematically analyzed, where Socio-Ecological Model (SEM) was applied as a theoretical framework. The study showed that the factors such as the knowledge of women, perception, and decision-making-autonomy at individual levels influenced maternal and child healthcare-seeking behaviors. Likewise, mothers-in-law and the role of husbands at intrapersonal levels, employment at institutional levels, peers and role of neighbors at community levels, and safe motherhood program at policy levels were significant factors for the utilization of maternal and child healthcare-seeking-behaviors. The negligence of women concerning pregnancy, inadequate health facilities, lack of specialist health workers with advanced equipment, and cultural taboos and beliefs were observed as score barriers for utilization of maternal and child health-seeking behaviors. The research strongly recommends that all women be aware of maternal and child healthcare and health-seeking behaviors at their initial ages.

Factors Influencing Caregivers’ Health Seeking Behavior for Malaria Treatment of Children Under 5 Years in Busia Municipality, Uganda

Background: Malaria remains a serious cause of under-five mortality and morbidity worldwide and Uganda inclusive. This burden can be minimized by promptly seeking health care. In Uganda, however, studies around malaria health-seeking behaviors for under-five children in the most malaria prevalent areas are very few. This study aimed at determining the factors influencing caregivers’ health-seeking behavior for malaria treatment of children under five years in Busia Municipality, Uganda. Methods: A cross-sectional research design was used with a structured questionnaire to collect data. Data were analyzed using SPSS Version 22 to establish relationships between the variables. Results: The results showed that the current health-seeking behaviors of the caregivers of under-five children in Busia municipality are associated with caregiver education level (p= 0.008), the health worker’s behavior towards the client (p=0.015), the severity of fever (p<0.001), the severity of last malaria episode (p<0.001), waiting time (p=0.001), the quality of health services (p= 0.001) and age of caregiver (p<0.001). Traditional medicine and home remedies are the most utilized means of malaria management in under-five children in Busia Municipality. Conclusions: Caregivers need to be sensitized about the proper health-seeking behaviors for the management of malaria in children under-five years through radio shows, television, community engagement meetings among others to enhance the knowledge and understanding of communities about the recommended malaria treatment-seeking practices. There is a need to continuously train medical workers on client engagement skills to promote a good relationship with patients and encourage their return.

Health Seeking Behaviors among Displaced Populations/Refugees

The United States resettles refugees every year. Their population in south-central Kentucky (KY) is diverse and fitting to research into culture-dependent healthcare utilization patterns. A mixed study was conducted with one hundred and ten semi-structured questionnaires and three individual interviews. Significant differences were observed between the use of healthcare services and refugees’ nationality (F (5, 98) = 4.29, p < 0.001), acculturation (t = −2.03, p < 0.04), and interpreters (t = 1.92, p < 0.05). Beliefs affect use through the level of cultural competency of the healthcare provider. These findings contribute to the health policy debates surrounding this culturally diverse population.

Changes in Stroke Patients’ Health-Seeking Behavior by COVID-19 Epidemic Regions: Data from the Korean Stroke Registry

<b><i>Introduction:</i></b> The coronavirus disease 2019 (COVID-19) pandemic has led to changes in stroke patients’ healthcare use. This study evaluated changes in Korean stroke patients’ health-seeking behaviors and stroke care services using data from the Korean Stroke Registry (KSR). <b><i>Methods:</i></b> We reviewed data from patients with acute stroke and transient ischemic attack (TIA) during 2019 (before COVID-19 period) and 2020 (COVID-19 period). Outcomes included patient characteristics, time from stroke onset to hospital arrival, and in-hospital stroke pathways. Subgroup analyses were performed for an epidemic region (Daegu city and Gyeongsangbuk-do region, the D-G region). <b><i>Results:</i></b> The study included 1,792 patients from the pre-COVID-19 period and 1,555 patients from the COVID-19 period who visited hospitals that contribute to the KSR. During the COVID-19 period, the D-G region had two-thirds the number of cases (vs. the pre-CO­VID-19 period) and a significant decrease in the proportion of patients with TIA (9.97%–2.91%). Unlike other regions, the median onset-to-door time increased significantly in the D-G region (361 min vs. 526.5 min, <i>p</i> = 0.016), and longer onset-to-door times were common for patients with mild symptoms and who were in their 60s or 70s. The number of patients who underwent intravenous thrombolysis also decreased during the COVID-19 period, although the treatment times were not significantly different between the 2 periods. <b><i>Discussion/Conclusion:</i></b> Korean stroke patients in a CO­VID-19 epidemic region exhibited distinct changes in health-seeking behaviors. Appropriate triage system and public education regarding the importance of early treatment are needed during the COVID-19 pandemic.

Promoting Fish Consumption Messages: Perspectives of Hmong Women of Childbearing Age

Objectives: Through focus groups, we aimed to understand ways to promote safe and healthy fish consumption among Hmong women in Minnesota. Methods: English-speaking Hmong women aged 18-40 were eligible to participate in 90-minute focus groups. Through our questions, we sought to gain understanding of the women's health-seeking behaviors and to obtain feedback on current messaging. We recorded the focus groups and transcribed and double-coded the data using sequential directed content analysis. Results: Thirteen Hmong women participated across 3 focus groups. The final coding tree included 6 primary themes related to health messaging, with adequate inter-coder reliability for each. Women identified the Internet as the primary source of health information with website preferences driven in-part by preferences of elders. Discrepancies between health beliefs of elder and younger generations were noted, with some evidence that personal fish consumption preferences outweighed cultural norms. Messages clearly targeting the Hmong population were preferred, with discrepancy in risk-versus benefit-framed messages. Conclusions: Findings highlight the need for culturally informed messages that are clear and carefully tailored. Our findings will inform future development of safe and healthy fish consumption messaging to better support the Hmong community in Minnesota.

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

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.

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

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.

Diagnosis and treatment of sexually transmitted infections in male partners of pregnant women in Brazil

Sexually transmitted infections (STIs) can adversely affect a woman’s pregnancy and the health of the developing fetus. The source of these infections may be the male sexual partner who remains under-diagnosed and un-treated due to a combination of lack of symptoms, decreased access to health care, and poor health-seeking behaviors. From September 2018 to November 2019, we offered a cohort of pregnant women (gestational age range: 4.6–41 weeks) clinic-based STI testing for HIV and syphilis (via lateral flow assay rapid tests) and for Neisseria (N.) gonorrhoeae, Chlamydia (C.) trachomatis, and Trichomonas (T.) vaginalis (via PCR-based testing) at Santa Casa Hospital and 10 affiliated prenatal clinics in Porto Alegre, Brazil. 400 women between the ages of 18 and 46 years (mean age: 27 years) enrolled and 24% were diagnosed with an STI. Each woman enrolled agreed to invite their male partners to clinic for the same panel of STI testing, and 255 men (64%) between the ages of 18 and 64 years (mean age: 29 years) attended clinic and all accepted full intervention. In these male partners, 40 (16%) were diagnosed with an STI including 22 (8.7%) testing positive for C. trachomatis, 15 (6%) for treponemal antibody (syphilis), 7 (2.8%) for T. vaginalis, 3 (1.2%) for N. gonorrhoeae, and 1 (0.4%) for HIV antibody. In our multivariate analysis, having symptoms of an STI (AOR 4.5, 95% CI 1.3–15.2) and arguing about jealousy (AOR 3.1, 95% CI 1.2–8.2) remained significantly associated with male diagnosis of an STI. Sexually transmitted infections are common in sexual partners of pregnant women in Brazil and should be addressed to prevent reinfection of pregnant women.