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BACKGROUND: Once malaria occurs, deaths can be prevented by prompt treatment with relatively affordable and efficacious drugs. Yet this goal is elusive in Africa. The paradox of a continuing but easily preventable cause of high mortality raises important questions for policy makers concerning care-seeking and access to health systems. Although patterns of care-seeking during uncomplicated malaria episodes are well known, studies in cases of fatal malaria are rare. Care-seeking behaviours may differ between these groups. METHODS: This study documents care-seeking events in 320 children less than five years of age with fatal malaria seen between 1999 and 2001 during over 240,000 person-years of follow-up in a stable perennial malaria transmission setting in southern Tanzania. Accounts of care-seeking recorded in verbal autopsy histories were analysed to determine providers attended and the sequence of choices made as the patients' condition deteriorated. RESULTS: As first resort to care, 78.7% of malaria-attributable deaths used modern biomedical care in the form of antimalarial pharmaceuticals from shops or government or non-governmental heath facilities, 9.4% used initial traditional care at home or from traditional practitioners and 11.9% sought no care of any kind. There were no differences in patterns of choice by sex of the child, sex of the head of the household, socioeconomic status of the household or presence or absence of convulsions. In malaria deaths of all ages who sought care more than once, modern care was included in the first or second resort to care in 90.0% and 99.4% with and without convulsions respectively. CONCLUSIONS: In this study of fatal malaria in southern Tanzania, biomedical care is the preferred choice of an overwhelming majority of suspected malaria cases, even those complicated by convulsions. Traditional care is no longer a significant delaying factor. To reduce mortality further will require greater emphasis on recognizing danger signs at home, prompter care-seeking, improved quality of care at health facilities and better adherence to treatment.

AbstractUnsafe abortions remain a considerable public health problem and continue to be a leading cause of maternal morbidity and mortality throughout the world. This study assessed whether women's choice of type of health care facility for abortion in India varied by their socio-demographic and economic characteristics, and aimed to determine the significant predictors of choice of health care facility. Data were taken from the 2015–16 Indian National Family and Health Survey (NFHS-4). The study sample included women aged 15–49 years, irrespective of their marital status, who had terminated their last pregnancy by induced abortion in the five years before the survey (N = 6876). A bivariate analysis was carried out to assess the pattern in the choice of health care facility type for an abortion, and a multinomial logistic regression model was fitted to assess the predictors affecting the choice of health care facility type for an abortion. The results showed that, at the time of the 2015–16 survey, women in India went to private facilities more than public facilities for abortion care, irrespective of their age, distance to facility and financial constraints. The probability of visiting a private facility increased with women's age, gestational age and the wealth quintile. A wide variation in choice of health facility for abortion care by socioeconomic characteristics was observed.

The paper deals with the development of zemstvo medicine in the late 19th and early 20th centuries, focusing on health care seeking. Within a broader research optics, this phenomenon is a key element in the formation of human capital and standard of living. In this paper, it is considered as the indicator of interaction between medical institu-tions and the population. The study reveals significant disparities in health care seeking behavior among counties in general and among counties within one province. The division of health care seeking into inpatient and outpatient sectors demonstrates distinct patterns of distribution for these types of medical care. Regression analysis demon-strates that infrastructural conditions and organizational factors of healthcare largely explain the distribution of inpatient services. However, a similar trend is not observed in the outpatient sector, indicating the likely influence of fac-tors of a different nature, such as sociocultural and socioeconomic factors. Furthermore, the study shows the insignif-icant influence of the factors of payment for medical care and the area of medical offices on the intensity of health care seeking in both the inpatient and outpatient sectors. These findings highlight the need for a more detailed study.

BACKGROUND: The health-related problems of the tribal population depend on their ecology and culture. Often the tribal people do not utilize the medical and preventive health services available to them. Health problems in tribal groups need special attention because many tribal communities are backward. The current study was planned to determine the healthcare-seeking behavior of the tribal population in India. METHOD: A descriptive, cross-sectional study, conducted by interviewing key respondents of each participating family. RESULT: Two-thirds of the key respondents were literate and half (53.8%) of the total households in the three villages had a per capita monthly income between Rupees 500-1499. More than half (57%) of all respondents preferred government institutions for moderate illness, and the rest equally opted for private practitioners and quacks. However, for emergencies, dog bites, and snake bites, all key respondents in the three study villages unanimously preferred government institutions. A significant population (38.5%) got their children delivered at home. The majority of illiterate respondents (86.1%) preferred government institutions for health care of under-five children, while 60% of literates expressed a similar view. The choice of government institutions as a source of health care was increasingly favored with decreasing per capita monthly household income. CONCLUSION: Traditional healers are no longer preferred among the tribal population but they are reluctant to avail them because of the loss of valuable time. Home delivery is still prevalent. With improving socioeconomic status, people are going further away from government services as private practitioners, and quacks take less time.

Thesis (Ph.D. (Population and Development))--National Institute of Development Administration, 1993. ; The objectives of this study are to estimate the number of ill persons and sources of midical care, to identify factors influencing the probability of seeking medical care, as well as to estimate the amount of expenditure for the outpatients, inpatients in public and private hospital. Secondary data were obtained from two major sources : The 1986 Health and Welfare Survey undertaken by the National Statistics Office and other national data from the National Economic and Social Development Board. Primary data about private hospital was assembled from 7 hospitals, four of them are in Bangkok, the others were in Songkhla, Khonkaen and Chiangrai. The decision making of the ill person to take treatment options were utilized as a dependent variable and number of demographic, socioeconomics factors were regressed on it. The relationship between the dependent variable and the predicting variables was examined by a binary logistic regressional method. The logit result shows that the profession occupation, female, the urban resident, and person and whose who, have a larger family size tended to have a higher probability of receiving modern treatment. Availibility and accessibility factors had significantly strong relation to the probability of seeking treatment. For children age group 0-4, no predictor variables except GPP were related significantly to the probability of seeking treatment. For the other age groups no demographic factors, except family size were related significantly to the probability of seeking treatment. Number of ill persons increased up to the year 2015, resulting in an increase in the medical care expenditure both in public and private sector. The government should encourage the private sector to take a burden of health care provision by improving and relaxing rules an regulations on the role of private health care institutions. ...

Abstract Background Healthcare-seeking behaviour in patients with diabetes mellitus (DM) has been investigated to a limited extent, and not in developing countries. Switches between different health sectors may interrupt glycaemic control, affecting health. The aim of the study was to explore healthcare-seeking behaviour, including use of complementary alternative medicine (CAM) and traditional healers, in Ugandans diagnosed with DM. Further, to study whether gender influenced healthcare-seeking behaviour. Methods This is a descriptive study with a snowball sample from a community in Uganda. Semi-structured interviews were held with 16 women and 8 men, aged 25-70. Data were analysed by qualitative content analysis. Results Healthcare was mainly sought among doctors and nurses in the professional sector because of severe symptoms related to DM and/or glycaemic control. Females more often focused on follow-up of DM and chronic pain in joints, while males described fewer problems. Among those who felt that healthcare had failed, most had turned to traditional healers in the folk sector for prescription of herbs or food supplements, more so in women than men. Males more often turned to private for-profit clinics while females more often used free governmental institutions. Conclusions Healthcare was mainly sought from nurses and physicians in the professional sector and females used more free-of-charge governmental institutions. Perceived failure in health care to manage DM or related complications led many, particularly women, to seek alternative treatment from CAM practitioners in the folk sector. Living conditions, including healthcare organisation and gender, seemed to influence healthcare seeking, but further studies are needed.

BACKGROUND: Healthcare-seeking behaviour in patients with diabetes mellitus (DM) has been investigated to a limited extent, and not in developing countries. Switches between different health sectors may interrupt glycaemic control, affecting health. The aim of the study was to explore healthcare-seeking behaviour, including use of complementary alternative medicine (CAM) and traditional healers, in Ugandans diagnosed with DM. Further, to study whether gender influenced healthcare-seeking behaviour. METHODS: This is a descriptive study with a snowball sample from a community in Uganda. Semi-structured interviews were held with 16 women and 8 men, aged 25-70. Data were analysed by qualitative content analysis. RESULTS: Healthcare was mainly sought among doctors and nurses in the professional sector because of severe symptoms related to DM and/or glycaemic control. Females more often focused on follow-up of DM and chronic pain in joints, while males described fewer problems. Among those who felt that healthcare had failed, most had turned to traditional healers in the folk sector for prescription of herbs or food supplements, more so in women than men. Males more often turned to private for-profit clinics while females more often used free governmental institutions. CONCLUSIONS: Healthcare was mainly sought from nurses and physicians in the professional sector and females used more free-of-charge governmental institutions. Perceived failure in health care to manage DM or related complications led many, particularly women, to seek alternative treatment from CAM practitioners in the folk sector. Living conditions, including healthcare organisation and gender, seemed to influence healthcare seeking, but further studies are needed.

Abstract Background The state of maternal healthcare (MHC) in Bangladesh is a grave concern especially in the remote haor areas. In this study, we aimed to determine the factors affecting the utilization of MHC services in the haor areas, to discover mothers' knowledge of MHC, and explore their attitudes toward MHC as well as practices in seeking MHC services. Method In this cross-sectional survey ( n = 400), we randomly selected mothers (aged 15–49 years) from haor areas of the Habiganj district of Bangladesh. The study participants' socio demographic information as well as the extent of their knowledge about MHC, their attitudes, and practices in seeking MHC services were ascertained. The degree of association between the respondents' socio-demographic characteristics and their health-seeking behavior (before, during, and after childbirth) was assessed by the odds ratio (OR) with 95 % confidence intervals (CI) estimated from the bivariate and multivariable logistic regression analyses. Results The mean age of the study participants was 27.26 years. Respondents had an average of 2.64 children, and 88.6 % had at best a primary education or less. Among the study participants, 61 % of mothers had no knowledge about the availability of MHC in the study area, and only 36 % received any antenatal care (ANC). Also, 47 % sought ANC from government healthcare institutions. Irrespective of complications and potential danger signs, 95 % of births were delivered at home with the assistance of untrained birth attendants. Only 19.75 % of mothers and 12.3 % of infants received postnatal care (PNC). Moreover, mothers who had a secondary or tertiary education level had a higher likelihood of receiving ANC (OR: 3.48, 95 % C.I: 1.49–7.63) compared to mothers with no education. Also, mothers aged 25 years or older were less likely (OR: 0.24, 95 % C.I: 0.06–0.095) to give birth in a health facility than mothers who were younger than 25. The low utilization of MHC services can be attributed to many factors such as a lack of communication, a lack of knowledge about MHC services, low income, decision making, and the lack of a companion with whom to visit health services. Conclusion To improve MHC utilization, to reach national targets and to save the lives of mothers and newborns, boat or ship-based special healthcare and educational programs should be implemented in the haor areas.

In Nigeria women frequently suffer the outcomes of serious hypertensive disorders in pregnancy that may lead to death. Delay in seeking care is a key contributor to worsening the complications of Pregnancy induced hypertension PIH. This study therefore aimed at contributing to the available body of research on the knowledge and Health seeking behaviour among pregnant women 18 to 40 years diagnosed with PIH in Ekiti-state Nigeria. Data was collected through the use of questionnaire from pregnant women who have been diagnosed with PIH. Research findings show that the level of knowledge of pregnancy induced hypertension among expectant mothers aged 18 to 40 years with PIH complications in Ekiti-state Nigeria is so low 15. Again the rate at which they seek healthcare 15.8 calls for urgent attention. In order to checkmate early complications of unmanaged PIH maternal foetal and neonatal mortality and morbidity it is therefore recommended that appropriate health interventions and education programmes for the pregnant women with PIH should be designed by the government of Ekiti-State Nigeria. For interventions to work the knowledge gained via this study would sensitize midwives on knowledge needs of pregnant women with PIH previously unrealized thereby strengthening the quality of antenatal care education. In conclusion there is a significant relationship between the level of knowledge of expectant mothers and the frequency at which they seek health care the point at which they seek healthcare as well as the alternative choices available to them.

Background The state of maternal healthcare (MHC) in Bangladesh is a grave concern especially in the remote haor areas. In this study, we aimed to determine the factors affecting the utilization of MHC services in the haor areas, to discover mothers? knowledge of MHC, and explore their attitudes toward MHC as well as practices in seeking MHC services. Method In this cross-sectional survey (n?=?400), we randomly selected mothers (aged 15?49 years) from haor areas of the Habiganj district of Bangladesh. The study participants? socio demographic information as well as the extent of their knowledge about MHC, their attitudes, and practices in seeking MHC services were ascertained. The degree of association between the respondents? socio-demographic characteristics and their health-seeking behavior (before, during, and after childbirth) was assessed by the odds ratio (OR) with 95æ% confidence intervals (CI) estimated from the bivariate and multivariable logistic regression analyses. Results The mean age of the study participants was 27.26æyears. Respondents had an average of 2.64 children, and 88.6æ% had at best a primary education or less. Among the study participants, 61æ% of mothers had no knowledge about the availability of MHC in the study area, and only 36æ% received any antenatal care (ANC). Also, 47æ% sought ANC from government healthcare institutions. Irrespective of complications and potential danger signs, 95æ% of births were delivered at home with the assistance of untrained birth attendants. Only 19.75æ% of mothers and 12.3æ% of infants received postnatal care (PNC). Moreover, mothers who had a secondary or tertiary education level had a higher likelihood of receiving ANC (OR: 3.48, 95æ% C.I: 1.49?7.63) compared to mothers with no education. Also, mothers aged 25æyears or older were less likely (OR: 0.24, 95æ% C.I: 0.06?0.095) to give birth in a health facility than mothers who were younger than 25. The low utilization of MHC services can be attributed to many factors such as a lack of communication, a lack of knowledge about MHC services, low income, decision making, and the lack of a companion with whom to visit health services. Conclusion To improve MHC utilization, to reach national targets and to save the lives of mothers and newborns, boat or ship-based special healthcare and educational programs should be implemented in the haor areas.

Abstract Background As in many European countries, access to care is decreased for undocumented migrants in the Netherlands due to legislation. Studies on the health of undocumented migrants in Europe are scarce and focus on care-seeking migrants. Not much is known on those who do not seek care. Methods This cross-sectional study includes both respondents who did and did not seek care, namely undocumented migrants who have been incarcerated in a detention centre while awaiting expulsion to their country of origin. A consecutive sample of all new arrivals was studied. Data were collected through structured interviews and reviews of medical records. Results Among the 224 male migrants who arrived at the detention centre between May and July 2008, 173 persons were interviewed. 122 respondents met inclusion criteria. Only half of the undocumented migrants in this study knew how to get access to medical care in the Netherlands if in need. Forty-six percent of respondents reported to have sought medical help during their stay in the Netherlands while having no health insurance (n = 57). Care was sought most frequently for injuries and dental problems. About 25% of these care seekers reported to have been denied care by a health care provider. Asian migrants were significantly less likely to seek care when compared to other ethnic groups, independent from age, chronic health problems and length of stay in the Netherlands. Conclusion The study underlines the need for a better education of undocumented patients and providers concerning the opportunities for health care in the Netherlands. Moreover, there is a need to further clarify the reasons for the denial of care to undocumented patients, as well as the barriers to health care as perceived by undocumented migrants.