Knowledge, acceptability and utilization of epidural analgesia in antenatal clinic attendees at UNIOSUN Teaching Hospital (UTH), Osogbo, Osun State

Labour pain is perceived as the most harrowing and agonizing event of a woman's life. Efforts at reducing the pain and making the event less stressful have predated modern obstetric practice. Epidural analgesia has provided effective pain relief in labour for over three decades. Delivery with epidural analgesia is routine for willing parturients in the developing world, however ignorance, cost as well as lack of qualified personnel has made this to be out of reach of the average Nigerian mother. The aim of this study was to assess level of awareness, acceptability, previous utilization and willingness to utilize epidural analgesia in labour following health education.Subjects/Methods: This cross-sectional study was carried out in the antenatal clinic of UTH, Osogbo. Health education on events of labour and methods of analgesia available was provided to all antenatal clinic attendees between September 2021and March 2022, following which a semi­structured purpose designed, and self- administered questionnaire was administered to 415 of these women who consented to participate in this study. Results: The mean age of the respondents was 32.57± 4.42 years and mean parity of 1.73± 0.96. 70.8% reported that labour pain was severe. 41.7% were aware of epidural analgesia before the health talk. 3.6% of our subjects had utilized epidural in their last confinement. However, only 47.7% expressed a wish to utilize epidural analgesia in labour. Conclusion: Awareness of epidural analgesia in study population was passable at 40% however willingness to utilize it was less than average despite health talk and reassurance by their attending obstetric team.

Contraceptive acceptability and associated factors among young women (15-24) living with HIV/AIDS: a hospital-based study in Kampala, Uganda

introduction: In Uganda, over 43% of all pregnancies among young women (15-24 years) living with HIV are either unwanted or mistimed. Unintended pregnancies account for 21.3% of neonatal HIV infections. The objective was to determine acceptability of contraceptives and associated factors among young women living with HIV attending HIV clinics in Kampala. Methods: Between February and May 2019, 450 young women attending public HIV clinics (Kisenyi HC IV, Kiswa HC III and Komamboga HC III) in Kampala were systematically enrolled in a cross-sectional study and interviewed using structured questionnaires. We used modified Poisson regression to determine the factors associated with acceptability of contraceptive. Data were analyzed using STATA 13.0. Statistical significance was determined at a P values < 0.05. Results: Contraceptive acceptability was 40.7% (95% CI: 27.6%-53.6%). Older age group (20-24 years) (aPR; 2.42, 95%CI; 1.06-5.52, P = 0.035), age at sex debut ≥ 18 years (aPR;1.25,95%CI; 1.13-1.38, P<0.001), having friend on contraceptives (aPR; 1.90, 95%CI; 1.10 - 3.26; P =0.021) and being married (aPR; 1.20, 95%CI; 1.09 - 1.32, P<0.001) were significantly associated with acceptability of contraceptives. Conclusion: There is a low acceptability for contraceptives. Younger age group who are not yet married need to be targeted

Postnatal Care Utilization and Associated Factors among Mothers who gave Birth in the Aysaeta District, Northeast Ethiopia: A Community Based Cross-sectional Study

BACKGROUND: Postnatal care is given to mothers and newborn babies within 42 days of delivery. It is a period of high maternal and newborn mortality and is also the most neglected in terms of maternal health services in many parts of the world. This study aimed to assess postnatal care and associated factors among mothers who gave birth in the year preceding the survey of the Ayssaeta district. METHODS: A community-based cross-sectional study was conducted among 406 mothers who gave birth in the year preceding the survey from August 02­30, 2020. Bivariable and multivariable logistic regression analyses were done to identify factors associated with postnatal care utilization. RESULTS: Slightly greater than four out of ten mothers have visited postnatal care units at least once. Living in urban areas, giving birth in a health facility, having complications during labor and after, and getting advice during antenatal care visits were associated with higher odds of postnatal care utilization. CONCLUSION: Less than half of the mothers received postnatal care following the delivery of their last child. Living in an urban, place of delivery, experiencing labor and postpartum complications, and receiving postnatal care advice during antenatal care have affected the utilization of postnatal care. Promoting skilled delivery and antenatal care with a focus on rural areas can help mothers learn about postnatal care and increase the number of mothers who use it

Acceptance of COVID-19 vaccine among adults in two Urban local government areas of Kwara State, North Central Nigeria

Background Covid-19 has unquantifiable negative impacts on the world's socio-economic parameters. The rapid discovery of vaccines to fight this pandemic is a monumental scientific breakthrough. Study objective The study assessed willingness of adult Nigerians to accept Covid-19 vaccine and elucidated on factors influencing such decisions. Methodology Cross-sectional design was employed among 400 respondents recruited using multi-stage random sampling technique in Ilorin, Kwara-State, Nigeria. Pretested interviewer-administered, semi-structured questionnaire was used for data collection. Both descriptive and inferential statistics were carried out. Results Mean age ±SD of respondents was 40.85±13.75 and 215 (53.7%) of them were males. Those who possessed good knowledge of Covid-19 were 321 (80.3%), but few respondents had misconceptions regarding its causation. Attitude to Covid-19 vaccination was positive in 360 (90%) of the respondents, 278 (69.5%) were willing to accept the vaccine. Respondents' Covid-19 knowledge and attitude to its vaccination were the main determinants of willingness to receive the vaccine. Conclusion The Nigerian government urgently needs to leverage on the positive attitude of the people to fully implement its covid-19 vaccination policies which can ensure effective coverage and equitable access to the revolutionary Covid-19 vaccines. Awareness campaign on practice of other preventive measures should be sustained to produce a synergistic control effort

Preferences, Utilization and Factors affecting Use of Contraceptives amongWomen attending Primary Health Care Facilities in Delta State,Southern Nigeria

Contraceptive use has numerous benefits for thefamily and the nation that can be maximized with its consistent use.However, many women have preferences for certain contraceptiveswith implications for continued use.OBJECTIVE: To determine the contraceptive preferences of women,their utilization pattern and factors affecting utilization of the preferredcontraceptive choices.METHODS: This cross-sectional study was conducted among 426women of reproductive age selected from 32 primary health facilitiesusing multistage sampling technique. Data was collected using a semi-structured interviewer-administered questionnaire. Descriptive andinferential analysis of data collected was carried out using IBM SPSSversion 22 software. P-value was set at 0.05.RESULTS: Close to half of the respondents 211 (49.5%) preferredinjectable contraceptives, 79 (18.6%) selected implants and 27 (6.3%)chose condoms. The majority 212 (49.8%) of respondents usedinjectable contraceptives, followed by implants 66 (15.5%), condoms33 (7.7%), IUCD 54 (12.7%) and OCP 61 (14.3%). Age (p<0.001),number of children (p<0.001), clients' employment status (p<0.001),husband support (p<0.021) and desire for more children (p<0.001)were all statistically associated with the utilization of preferredcontraceptives.CONCLUSION: Even though respondents preferred the injectablecontraceptives, implants and IUCD in that order, their utilizationpattern followed the order of Injectable, implants and OCP. Severalfactors were identified to be statistically associated with the utilizationof preferred contraceptives. Health education on contraceptive useamong women, spousal support and health workers training tohighlight those factors influencing women's contraceptive preferencesand utilization are recommended

COVID 19: determinants and barriers to infection prevention and control practice among residents in Bonny Island, Rivers State

Background: Coronavirus disease 2019 (COVID-19) which was declared a pandemic and described as a disease of public health emergency caused worldwide disruption of business activities, education, tourism and health challenges including death. Prevention is a viable strategy to contain the pandemic, including the use of vaccines. However, evidence abound which reveals that majority of people do not comply with proposed health and safety measures recommended by World Health Organization (WHO) and their respective country health authorities. This study identified socio-demographic and other variables which may influence compliance to practice of infection prevention and control (IPC) measures. Method: This is a descriptive cross-sectional study conducted at zonal hospital Bonny. All eligible respondents who visited the hospital for Medicare were included into the study until sample size was achieved. Pretested interviewer administered questionnaire was used to elicit information from respondents. Multinomial regression analysis was used to analyze data with statistical significance set at 0.05. Ethical clearance, permission for the study and informed consent were derived from relevant authorities and respondents respectively. Result: Compliance to good IPC measures was 73.9%. There was statistically significant compliance to good practice among public servants, respondents aged 31-40 years and females. Conclusion: Good IPC measures was high among respondents, COVID 19 vaccine acceptance was poor, while factors such as inability to procure personal protective equipment and non-availability of water were responsible for poor compliance

"It is just a lot to deal with": A qualitative study exploring the sexual and reproductive health needs of a sample of female sex workers in six locations in Southern Africa

The sexual and reproductive health of female sex workers in Southern Africa is particularly important, given the high prevalence of HIV among this population. This paper presents the results of a rapid assessment study conducted prior to the implementation of the "SRHR-HIV Knows No Borders" project in six Southern African countries. Trained interviewers interviewed 20 sex workers across 10 high migration communities. Data were analysed thematically. Participants were well informed about and were able toaccess preventive methods for STIs and pregnancy, although reports of condom failures were common. While sex workers found SRH services easily accessible, many reported experiences of stigma and discrimination when accessing them. Physical and sexual violence were common occurrences among participants, both from their clients and the police. In addition to addressing stigma within the healthcare and broader community, interventions could provide opportunities for those looking to exit the industry by providing skills training and microfinance support. (Afr J Reprod Health 2022; 26[5]: 72-80).

Determinants of COVID-19 vaccine acceptance and hesitancy among healthcare professionals in the Kintampo North Municipality, Bono East Region, Ghana

tives: To assess the determinants of COVID-19 vaccine acceptance and hesitation among Health Care Professionals (HCPs) in the Kintampo North Municipality of Ghana. Design: An analytical cross-sectional study. Setting: The study was carried out in the Kintampo North Municipality. Participants: All health care professionals within the Kintampo North Municipality of Ghana. Main outcome measure: Acceptance of COVID-19 vaccine. Results: In all, 215 HCPs were included in this study. The overall vaccine acceptance was 78.6% among HCPs, while 21.4% were hesitant to receive the COVID-19 vaccine. Majority (57.7%) of HCPs believed that COVID-19 vaccines were safe. The following factors were found to influence vaccine acceptance significantly; those who knew someone who has taken the vaccine (adjusted Odds Ratio [aOR]; 14.9, 95% Confidence Interval [95% CI];5.0-45.0, p<0.001), those who think COVID -19 vaccine in Ghana was safe (AOR;9.2, 95%CI;3.3-25.8, P<0.001), those who said vaccines are effective in controlling COVID-19 transmission (aOR=5.0, 95%CI;2.1-12.4, p<0.001), and those who have never refused vaccines in the past (aOR=7.8, 95CI;1.6-37.8, p=0.01). Conclusion: The study indicated high COVID-19 vaccination acceptability among HCPs. However, some HCPs are hesitant to take COVID-19 vaccinations immediately. Increased adoption of COVID-19 vaccinations among HCPs and the broader Ghanaian population requires concerted efforts, including strengthening public health education on the perceived risks and safety of COVID-19 vaccines

Couverture vaccinale et raisons de l'acceptation et de l'hésitation à la vaccination contre la COVID-19 chez les patients porteurs de pathologie cardiovasculaire à Ouahigouya / Vaccination coverage and reasons for accept ance orhesitation in vaccination against COVI D-19 in patients with cardiovascular disease in Ouahigouya

Objectif. La pandémie de COVID-19 a été cause d'une mortalité élevée chez les patients porteurs de comorbidités comme les pathologies cardiovasculaires. L'accélération de la mise sur marché des vaccins contre la pandémie a suscité une réticence envers ces derniers. L'étudié porte sur l'attitude des patients porteurs de pathologie cardiovasculaires vus en consultation cardiologique à Ouahigouya vis-à-vis de la vaccination contre la COVID-19. Population et méthodes. Une étude transversale a été menée du 1er au 25 avril 2022 dans trois cliniques privées de la ville de Ouahigouya. Nous avons inclus les patients consentants et porteurs de pathologie cardiovasculaire vus en consultation cardiologique. Le questionnaire était centré sur les connaissances, attitudes et pratiques de groupe vis-à-vis de la vaccination, notamment les raisons de 'l'acceptation ou du refus de se faire vacciner. Résultats. Cent-un patients ont été interviewés. Le sex-ratio était 1,46 avec un âge moyen de 48,26 ± 11,93 ans. Les plus représentés étaient les travailleurs indépendants, les urbains, les musulmans, les non-scolarisés et les mariés. L'HTA et ses complications étaient les atteintes cardiovasculaires les plus fréquentes (93,07%). La proportion de vaccinés était de 55,45%. Les raisons les plus évoquées par les vaccinés pour se vacciner étaient pour se protéger (100%) et le suivi des Recommandations gouvernementales et des agents respectivement 78,52% et 72,21%. Les raisons de l'hésitation vaccinale les plus citées étaient : la COVID-19 est une maladie banale (62,22%) et la peur des effets secondaires (44,44%). Conclusion. La vaccination contre la COVID-19 devrait se poursuivre, accompagnée d'une sensibilisation efficace afin d'améliorer le taux de couverture vaccinale parmi les patients porteurs de pathologies cardiovasculaires

Objective. COVID-19 pandemic has caused high mortality in patients with comorbidities such as cardiovascular pathologies. The acceleration of the marketing of vaccines against the pandemic has caused reluctance towards them. The study focuses on the attitude of patients with cardiovascular disease seen in cardiology consultation in Ouahigouya vis-à-vis COVID-19 vaccination. Population and methods. A cross-sectional study was conducted from April 1 to 25, 2022 in three private clinics of the city of Ouahigouya. We included consenting patients and carriers of cardiovascular pathology seen in cardiology consultation. Our main data of interest were the knowledge, attitude and practice of this population towards vaccination, especially thereasons for accepting or refusing vaccination. Results One hundred and one patients were interviewed. The sex ratio was 1.46 with an average age of 48.26 ± 11.93 years. The most represented were the self-employed, urban dwellers, Muslims, the uneducated and the married. Hypertension and its complications were the most common cardiovascular disorders (93.07%). The proportion of vaccinated was 55.45%. The reasons most mentioned by the vaccinated for getting vaccinated were to protect themselves (100%) and to follow government recommendations and agents, respectively 78.52% and 72.21%. The most cited reasons for vaccine hesitation were: COVID-19 is a common disease (62.22%) and fear of side effects (44.44%). Conclusion. Vaccination against COVID-19 must continue, accompanied by effective awareness-raising in order to improve the vaccination coverage rate among patients with cardiovascular pathologies

Perception of COVID-19 and acceptance of vaccination in Delta State Nigeria

Background: With more than 80 million recorded cases and over 1.7 million deaths at the time of this research, providing safe effective vaccine to curb the ravaging COVID-19 has emerged a global priority. Public attitude towards COVID-19 and interventions like vaccination varies considerably as the access to knowledge. This study looked at knowledge of COVID-19 and its impact on acceptance of the upcoming vaccination in Delta State, Nigeria. Method: Cross-sectional survey of 401 participants from three Local Government Areas in Delta North, Central, and South Senatorial Districts carried out in December 2020. Data collected by Google forms was analyzed using Microsoft Excel and SPSS. Results: For COVID-19 knowledge, 75.6% of respondents were aware of the cause and 81.2% had knowledge of mode of transmission. For preventive measures, 77.6% practice social distancing, 65.6% hand washing, 61.6% use of hand sanitizers and 67.6% wearing of masks. Also, 76.6% knew about the vaccines in development, 53.9% were aware of Nigeria's interest in rolling out the vaccine and 48.6% were willing to accept the vaccine. A statistically significant relationship at p < 0.05 was observed between vaccine acceptance and gender, religious affiliation, education, employment status, income, knew a person with COVID-19, self-reported susceptibility to COVID-19, and individual agreement with effectiveness of government COVID-19 interventions. Conclusion: The population had a good knowledge of COVID-19 and the vaccine, although more than half were not willing to accept it. This calls for interventions to encourage trust and compliance as the government sets out to invest in vaccine rollout.

Insights into vaccine hesitancy from systems thinking, Rwanda

Objective To investigate vaccine hesitancy leading to underimmunization and a measles outbreak in Rwanda and to develop a conceptual, community-level model of behavioural factors. Methods Local immunization systems in two Rwandan communities (one recently experienced a measles outbreak) were explored using systems thinking, human-centred design and behavioural frameworks. Data were collected between 2018 and 2020 from: discussions with 11 vaccination service providers (i.e. hospital and health centre staff ); interviews with 161 children's caregivers at health centres; and nine validation interviews with health centre staff. Factors influencing vaccine hesitancy were categorized using the 3Cs framework: confidence, complacency and convenience. A conceptual model of vaccine hesitancy mechanisms with feedback loops was developed. Findings/ A comparison of service providers' and caregivers' perspectives in both rural and peri-urban settings showed that similar factors strengthened vaccine uptake: (i) high trust in vaccines and service providers based on personal relationships with health centre staff; (ii) the connecting role of community health workers; and (iii) a strong sense of community. Factors identified as increasing vaccine hesitancy (e.g. service accessibility and inadequate follow-up) differed between service providers and caregivers and between settings. The conceptual model could be used to explain drivers of the recent measles outbreak and to guide interventions designed to increase vaccine uptake. Conclusion The application of behavioural frameworks and systems thinking revealed vaccine hesitancy mechanisms in Rwandan communities that demonstrate the interrelationship between immunization services and caregivers' vaccination behaviour. Confidencebuilding social structures and context-dependent challenges that affect vaccine uptake were also identified.

Acceptabilité du dépistage néonatal de la drépanocytose au cours de la pandémie au COVID-19 à Kisangani, en République Démocratique du Congo

Introduction: l´implémentation du dépistage néonatal de la drépanocytose pendant la pandémie se coronavirus (COVID-19) représente un défi majeur en République Démocratique du Congo (RDC). La présente étude vise à déterminer si des facteurs socio-économiques sont associés à l´acceptabilité du dépistage néonatal de la drépanocytose pendant la COVID-19 à Kisangani, en RDC. Méthodes: étude observationnelle conduite dans les maternités de Kisangani du 21 mars au 30 juin 2020 chez les mères sensibilisées au dépistage néonatal de la drépanocytose de leurs nouveau-nés à l´hemotypeSCTM (HT401RUO-USA). Les données recueillies étaient la parité, le niveau d´étude, l´âge, le niveau socio-économique, la profession, la notion de sensibilisation et le motif du refus du dépistage. Résultats: sur 55,5% (273/492) des mères sensibilisées, 107 (39,19 %) ont accepté et 166 (60,80 %) ont refusé le dépistage néonatal de la drépanocytose chez leur nouveau né. Les motifs du refus étaient l´absence d´information (67,5%;IC 95% [59,8-74,5]), le manque d´argent dû au confinement (66,3%;IC 95% [58,5-73,4]), la prise de sang pour tentative du vaccin anti-COVID-19 (63,2%; IC 95% = [55,4-70,6]). Les Facteurs associés à l´acceptabilité du dépistage étaient l´âge > 35 ans (p = 0,0009; ORa = 3,04; IC 95% = 1,57-5,87) et le bas niveau socio-économique (p = 0,0016; ORa = 2,29; IC à 95% = 1,37-3,85). Conclusion: l´acceptabilité du dépistage néonatal de la drépanocytose pendant la COVID-19 reste faible à Kisangani. Le gouvernement devrait identifier les canaux de communication efficaces afin de promouvoir les initiatives dans le secteur de la Santé

A task-sharing intervention for prepartum common mental disorders: Feasibility, acceptability and responses in a South African sample

Background: Peripartum common mental disorders (CMD) are highly prevalent in low- and middle-income countries (LMIC) such as South Africa. With limited public mental health resources, task sharing approaches to treatment are showing promise. However, little is known about the feasibility and acceptability of, as well as responses associated with problem-solving therapy (PST) for the treatment of prepartum CMD symptoms in South African public health settings. Aim: To investigate participants' preliminary responses to a task sharing PST intervention, and to evaluate the feasibility and acceptability of the intervention. Setting: A Midwife and Obstetrics Unit attached to a Community Health Centre in a Western Cape district. Methods: Using mixed methods, 38 participants' responses to a PST intervention, and their perceptions of its feasibility and acceptability, were explored. Primary outcomes included psychological distress (Self Reporting Questionnaire; SRQ-20) and depression symptoms (Edinborough Postnatal Depression Scale; EPDS). Semi-structured interviews were conducted three after the last session. Six stakeholders were also interviewed. Results: Significant reductions were seen on EPDS (Cohen's d = 0.61; Hedges g = 0.60) and SRQ-20 (Cohen's d = 0.68; Hedges g = 0.67) scores. The intervention's acceptability lay in the opportunity for confidential disclosure of problems; and in relieving staff of the burden of managing of patients' distress. Barriers included lack of transport and work commitments. Conclusion: Results support task sharing PST to Registered Counsellors to treat antenatal CMDs in perinatal primary health care settings. Research is needed on how such programmes might be integrated into public health settings, incorporating other non-specialists

Factors influencing health seeking behaviour among residents of Basawa community, Sabon Gari l.G.A. Kaduna State, Nigeria

Background: The health of the citizenry is crucial to the growth and development of any nation. Nigeria is riddled with poor health indices ranging from maternal mortality to infant mortality rates. It has been established that health-seeking behaviour has a strong influence on health status, morbidity and mortality indices of a society. It also drives utilisation of health services and is affected by predisposing, enabling and need factors. This study assessed the factors influencing health-seeking behaviour among residents of Basawa community, Sabon Gari LGA, Kaduna State, Nigeria. Method: This was a descriptive cross-sectional study carried out in September 2017 among 125 residents of Basawa community selected by systematic sampling technique. Data was collected using asemi-structured interviewer-administered questionnaire and analysed with SPSS version 21. The results were presented as tables and charts among others. Level of statistical significance was set at p <0.05. Results: The mean age of the respondents was 42±10 years. Majority of the respondents were male (60.8%) and married (90.4%). About two-thirds of the respondents delayed for more than 24 hours before seeking healthcare. Long waiting time (55.2%), the attitude of health workers (22.4%) and the high cost of drugs (22.4%) were given as barriers to health care utilisation. High cost of services, type and severity of illness and attitude of health care workers are the main determinants of health-seeking behaviour. There was a statistically significant relationship between education, monthly income and delay in seeking health care. Conclusion: The study showed several factors that influence health care seeking behaviour. In view of the multifactorial determinants of health-care seeking behaviour, there is need for health workers to be trained and retrained to improve on their attitude, and the provision of community-based social health insurance scheme by the government among others

Awareness, acceptability and barriers to the utilization of modern methods of family planning among women attending antenatal clinic in Bayero University, Kano

Background: Contraceptive prevalence rate (CPR) is generally very low in Nigeria, but particularly lowest in northern Nigeria. Barriers to access and utilization have been variously studied, but there is need to consider specific contexts. Objective: The aim of this study is to determine the level of awareness, acceptability, and barriers to the utilization of modern methods of family planning in Bayero University, Kano, North-west, Nigeria. Methodology: This was a cross-sectional study conducted at the antenatal section of BUK staff clinic, among 152 pregnant women between May and October 2013. Ethical approval and informed consent were obtained. Descriptive statistics was used to report categorical variables. Results: Awareness of modern methods of contraception was high (86.18%) and the majority (86.19%) knew at least one method of family planning. The commonest methods known by the respondents were: Oral contraceptive pills (39.47%), injectables (22.37%) and condom (14.47%). Out of the152 respondents, 77(50.66%) accepted the use of modern methods of family planning and 39(25.65%) out of these number had ever used at least one method, while 38(25.00%) did not. Fear of side effects (42.11%), desire for more children (15.79%), and lack of awareness (13.82%), religious prohibition (10.53%) and opposition by male partners (7.89%) constituted the major barriers to the utilization of modern methods of family planning. Conclusion: The level of awareness was found to be high but acceptability and utilization were low, this is due to the existing barriers to utilization of modern methods of family planning. Effort should be made to allay the fear of side effects and to educate women on the implication of frequent childbirth

Cost of treatment among self-referred outpatients in referral hospitals compared to primary health care facilities in East Wollega, western Ethiopia: a comparative cross-sectional study

Patient self-referral is a condition when patients refer themselves to higher level health facilities without having to see anyone else first. Despite the expansion in the number of health facilities, it has been seen when patients routinely accessed referral hospitals without a formal referral. The study aims to evaluate cost of treatment among self-referred outpatients at referral hospitals compared to primary health care facilities. Comparative cross-sectional study design was used and the required sample size for the study was determined by using formula of double populations mean comparison cost of treatment for diseases leading to outpatient visits. A total of 794 participants (397 from referral hospital and 397 from primary health facilities) were included in the study. Data was collected using face-to-face interview from December 1 to 30, 2017. Data entry and analysis were made using SPSS version 20. Descriptive statistics and independent samples t-test were performed. A total of 783 outpatients responded to the interview of the study and 391 of them were from referral hospital and 392 from primary health facilities. The mean of outpatient visit cost per visit for the treatment of diseases leading to outpatient visits was significantly higher at referral hospitals compared to primary health facilities [95% CI=6.13 (5.07-7.18)] USD. The mean cost of outpatient visits for the treatment of all type of diseases leading to outpatient visits was significantly higher at referral hospitals and at least two times of primary level health facilities. Health care providers should create awareness in the community about referral linkages to inform patients and their families the additional costs they incur when they bypass the proximal primary health facilities

Modern health-seeking behaviour and associated factors among mothers having under 5-years old children in Shire town, Tigray, Ethiopia: a cross-sectional study 2018

Background: The practice of appropriate health care-seeking is important to reduce severe and life-threatening childhood illnesses. In Shire town, little is known about the mother's health care-seeking behaviour on childhood illness. Aim: To assess modern health-seeking behaviour and associated factors of mothers having under 5-years old children in Shire town. Setting: The study setting was Shire town, northwest Tigray, Ethiopia. Methods: A community-based cross-sectional study was conducted to interview 504 mother-child pairs by systematic random sampling technique. Data were collected through interviewer-administered semi-structured questionnaires. Data were coded, entered, cleaned and edited using EPIDATA version 3.1 and export to Statistical Package for Social Science (SPSS) Version 22.0 for analysis. To identify the significant variables, binary logistic regression was employed. Variables with p-value < 0.05 at 95% CI (confidence interval) in multivariate logistic regression were considered statistically significant. Results: In this study, around 76.2% (72.1, 80) of mothers sought modern health care. In a multivariate logistic regression analysis at a p-value of < 0.05, caregivers with age of ≥ 28 years (AOR [adjusted odds ratios]: 1.65; 95% CI [1.02, 2.68]), educational level of secondary school and above (AOR: 0.44; 95% CI [0.23, 0.86]), child feeding per day < 8 times (AOR: 2.77; 95%CI[1.75, 4.38]) and perceived severity of illness (AOR: 2; 95% CI [1.07, 3.82]) were statistically associated with modern health care-seeking behaviour. Conclusion: Strengthen healthcare services is recommended at the community level through information, education and communication/behavioural change strategies to improve the mother's health care-seeking behaviour

Acceptance of an orange-fleshed sweet potato complementary food by infant caregivers in KwaZulu-Natal Province ­ a preliminary study

Background. Vitamin A deficiency (VAD) is a major public health problem that affects South African children and is a major contributor to the mortality of children under five years of age. VAD can result in visual impairment, diarrhoea and increased risk of severe measles and death. Orange-fleshed sweet potato (OFSP), a staple crop biofortified with provitamin A, has the potential to improve vitamin A intake in infants, especially when used as a complementary food.Objective. To assess the acceptance of an OFSP complementary food by infant caregivers.Methods. This study was conducted at the Newtown Community Health Centre, Inanda, in the eThekwini District of KwaZulu-Natal (KZN). Sixty-three infant caregivers assessed the acceptance of complementary foods made from OFSP and white-fleshed sweet potato (WFSP) (control), using a five-point hedonic rating test. In addition, ten caregivers participated in two focus group discussions, using pre-determined questions.Results. There were no statistically significant differences in the sensory attribute ratings of complementary foods made from WFSP and OFSP. The OFSP complementary food was well-accepted, especially its colour and soft texture. None of the focus group discussion participants had seen or tasted the OFSP before. Caregivers were willing to buy the OFSP, if it were available and cheaper than the WFSP.Conclusion. The complementary food made from the OFSP was highly acceptable to infant caregivers attending the Newtown Community Health Centre in KZN. It has the potential to be used in complementary feeding and to improve the vitamin A status of infants

Feasibility and acceptability of conducting HIV vaccine trials in adolescents in South Africa: Going beyond willingness to participate towards implementation

Background. HIV/AIDS remains a leading cause of death in adolescents (aged 15 - 25 years), and in sub-Saharan Africa HIV-related deaths continue to rise in this age group despite a decline in both adult and paediatric populations. This is attributable in part to high adolescent infection rates and supports the urgent need for more efficacious prevention strategies. In particular, an even partially effective HIV vaccine, given prior to sexual debut, is predicted to significantly curb adolescent infection rates. While adolescents have indicated willingness to participate in HIV vaccine trials, there are concerns around safety, uptake, adherence, and ethical and logistic issues.Objectives. To initiate a national, multisite project with the aim of identifying obstacles to conducting adolescent HIV vaccine trials in South Africa (SA).Method. A simulated HIV vaccine trial was conducted in adolescents aged 12 - 17 years across five SA research sites, using the already licensed Merck human papillomavirus vaccine Gardasil as a proxy for an HIV vaccine. Adolescents were recruited at community venues and, following a vaccine discussion group, invited to participate in the trial. Consent for trial enrolment was obtained from a parent or legal guardian, and participants aged 16 - 17 years were eligible only if sexually active. Typical vaccine trial procedures were applied during the five study visits, including the administration of vaccination injections at study visits 2, 3 and 4.Results. The median age of participants was 14 years (interquartile range 13 - 15), with 81% between the ages of 12 and 15 years at enrolment. Overall, 98% of screened participants opted to receive the vaccine, 588 participants enrolled, and 524 (89%) attended the final visit.Conclusions. This trial showed that adolescents can be recruited, enrolled and retained in clinical prevention trials with parental support. While promising, these results were tempered by the coupling of sexual-risk eligibility criteria and the requirement for parental/guardian consent, which was probably a barrier to the enrolment of high-risk older adolescents. Further debate around appropriate consent approaches for such adolescents in HIV prevention studies is required

Knowledge of tuberculosis and factors responsible for low case detection in the Amansie Central District, Ghana

Background:Tuberculosis (TB) case detection rate has remained consistently low in the Amansie Central District despite the implementation of the National TB Programme (NTP).Objective:To assess the factors influencing this low case detection of TB.Method:Information was collected from 120 individuals and 40 health workers were randomly selected from four health facilities that provided TB treatment. Results:All patients had a good knowledge of TB. There was no statistical association between patients knowledge and educational level (p>0.05). However, knowledge on the causes of TB was strongly associated with occupation (p<0.05). 53% of patients indicated health facilities as the first place of visit when sick and how they are received was dependent on education (p=0.005) and marital status (p<0.05); 60% of health workers were not trained on the NTP despite 93% being aware of the programme, and 62.5% reported not initiating contact tracing after disease confirmation. Only 34 of the 120 patients reported health workers visiting them regarding TB. Conclusion: Development of interventions such as HCW training on TB treatment and care, and establishing referral networks that bring TB information and services closer to community members can contribute to improved TB case notification