Barriers to the uptake of community-based curative child health services in Ethiopia

Background Uptake of services to treat newborns and children has been persistently low in Ethiopia, despite being provided free-of-charge by Health Extension Workers (HEWs). In order to increase the uptake of these services, the Optimizing the Health Extension Project was designed to be implemented in four regions in Ethiopia. This study was carried out to identify barriers to the uptake of these services and potential solutions to inform the project. Methods Qualitative data were collected in October and November 2015 in 15 purposely selected districts in four regions. We conducted 90 focus group discussions and 60 in-depth interviews reaching a total of 664 participants. Thematic analysis was used to identify key barriers and potential solutions. Results Five demand-side barriers to utilization of health services were identified. Misconceptions about illness causation, compounded with preference for traditional healers has affected service uptake. Limited awareness of the availability of free curative services for children at health posts; along with the prevailing perception that HEWs were providing preventive services only had constrained uptake. Geographic challenge that made access to the health post difficult was the other barrier. Four supply-side barriers were identified. Health post closure and drug stock-out led to inconsistent availability of services. Limited confidence and skill among HEWs and under-resourced physical facilities affected the service delivery. Study participants suggested demand creation solutions such as increasing community awareness on curative service availability and educating them on childhood illness causation. Maintaining consistent supplies and ensuring service availability; along with regular support to build HEWs’ confidence were the suggested supply-side solutions. Creating community feedback mechanisms was suggested as a way of addressing community concerns on the health services. Conclusion This study explored nine demand- and supply-side barriers that decreased the uptake of community-based services. It indicated the importance of increasing awareness of new services and addressing prevailing barriers that deprioritize health services. At the same time, supply-side barriers would have to be tackled by strengthening the health system to uphold newly introduced services and harness sustainable impact.

Nasa dugo (‘It’s in the blood’): lay conceptions of hypertension in the Philippines

IntroductionUnderstanding explanatory models is important for hypertension, a leading risk factor for cardiovascular disease and stroke. This article aims to determine what adult patients with hypertension in the Philippines attribute their condition to, how these views might be explained and what the implications are for hypertension management.MethodsThis is a qualitative study drawing on 71 semistructured interviews (40 initial and 31 follow-up) and four focus group discussions with patients diagnosed with hypertension. The setting was urban and rural low-income communities in the Philippines.ResultsFour prominent perceived causes were identified—genetics, heat, stress and diet—for what patients refer to as ‘high blood’. We propose a ‘folk physiology’ that rests on local understandings of blood and blood flow, draws from broader cultural notions of illness causation and accounts for a dynamic, non-chronic view of hypertension that in turn informs the health behaviours of those affected.ConclusionsBy understanding that hypertension is frequently seen not as a chronic constant condition but rather as an episodic one triggered by external influences, although in those genetically predisposed to it, it may be possible to address patient’s beliefs and thus adherence to treatment.

Supernatural versus medical: Responses to mental illness from undergraduate university students in Trinidad

Background/Introduction: Perceptions about the aetiology of mental illness are likely to influence help-seeking behaviour. Understanding help-seeking behaviour will improve service provision and access. Therefore, this is likely to improve treatment outcomes. Methods: We assessed the perceptions and help-seeking behaviours surrounding mental illness in a Trinidadian population of 158 tertiary-level students (136 female, 22 male; mean age 30) by analysing their responses to a questionnaire which asked for responses regarding a case vignette of a 25-year-old young woman exhibiting symptoms suggestive of schizophrenia. Results: Of the respondents, 32.3% attributed the symptoms to supernatural causes. Specifically, 27.8% to someone doing her bad and 24.1% to evil spirits. In all, 77.2% of respondents indicated that mental illness was caused by medical problems and 63.3% to work stress. A minimum of 9.5% of the students therefore have dual perceptions regarding causation (77.2 + 32.3 = 109.5) Those who perceived causation to be supernatural said they would seek help from both medical ( p = .000) and supernatural ( p = .000) modalities. This also applied significantly to those who said the causation was medical, that is, seeking both religious intervention ( p = .000) and medical intervention (.000) as the first path in the health-seeking pathway. Conclusion: Dual help-seeking behaviour seems to be the functional result of an integration of religious and medical models of mental illness causation even in respondents who clearly identified only one of these as the likely cause of the illness behaviour.

The Inadequate Life: Rural Industrial Pollution and Lay Epidemiology in China

Based on fieldwork in a heavily industrialized Yunnan village, this article examines how villagers understand and respond to pollution-related health risks. Building on Robert Weller's (2006) concept of environmental consciousness, it shows that Baocun villagers have developed an acute environmental health consciousness. However, despite earlier instances of collective activism, they no longer act as a community to oppose the harm to their bodies caused by pollution. The article investigates the role of uncertainty surrounding illness causation in deterring action. It argues that uncertainty about pollution's effects on health is reinforced by the social, political and economic contexts and developments in the past few decades. As a result, villagers engage in a form of “lay epidemiology” to make sense of the effects of pollution on their health, but not in a “popular epidemiology” consisting of collective action against presumed health damages. The article concludes with some thoughts on how locals act within and despite uncertainty.

Illness Causation and Interpretation in a Newar Town

One of the core concerns of medical anthropology is to explore how people in different cultures and social groups explain the causes of ill health, the type of treatment they believe in, and to whom they turn if they do become ill. This article focuses on the understanding of illness causation by the Newars in Kirtipur and their concern about biological and socio-cultural aspects of healthy behavior, and particularly with the ways in which they have been coping in everyday life. The basic method of data collection for this study was formal and informal discussions with the elderly Newar males and females, followed by discussions with youths to explore the variations in their perceptions. The findings show that the understanding of illness etiology is multi-causal. The individual, natural, social, and supernatural causes are not mutually exclusive but are usually linked together in a particular case. In any specific case of illness, moreover, people’s explanatory model varies in how they explain its etiology.DOI: http://dx.doi.org/10.3126/dsaj.v5i0.6358 Dhaulagiri Journal of Sociology and Anthropology Vol. 5, 2011: 101-120