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Abstract@#Utilization is an important indicator for health service planning and can be determined through the count of actual usage of health services. There are also several determinants to health care utilization. This systematic review aims to explore the technical components from spatial analysis in primary health care utilization, the determinants frequently discussed, and the gap in the spatial analysis from these studies. Two databases were searched according to search strategy. A total of 15 articles were eligible. Each study was different in terms of analysis unit, spatial analysis, and utilization outcome. Spatial accessibility, sociodemographic, and geographical aspect were the frequent determinants discussed among the study of spatial utilization in this review. Several studies found the association between the determinants with utilization. However, spatial analysis in primary health care utilization studies still subjected to several limitation in term of their unit of analysis and source of data.
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Abstract@#Introduction: Sustained optimal adherence to antiretroviral therapy (ART) is required for long-term suppression of viral replication. However, adherence level in Jos, Nigeria has been reported to be below optimal adherence, thus this study investigates the predictors of adherence to antiretroviral therapy among Human Immunodeficiency Virus (HIV) patients there. Methods: A validated and pretested questionnaire was used in this cross-sectional study to collect data on sociodemographic characteristics, duration of being on ART, alcohol consumption, presence of symptoms, drug type and disclosure status from 224 randomly selected adult HIV patients. Chi-square and binary logistics regression were used for data analysis. Level of significance was set at 0.05. Results: Only 14.3% of the respondents had optimal adherence. Adherence to ART is significantly associated with gender (p = 0.043), duration of ART use (p = 0.041), alcohol (p = 0.029), drug type (p = 0.001), and disclosure status (p = 0.004). Binary logistics regression reveals that females are 2.4 times more likely to have optimal adherence than males, patients on ART for over 10 years are 2.5 times more likely to have optimal adherence than those less than 10 years, and patients with disclosed HIV status are 3.3 times more likely to have optimal adherence than those who had not. Conclusion: Generally, the patients had suboptimal adherence. Being female, having longer duration on ART and disclosure status are predictors for optimal adherence. Intervention with emphasis on males and new patients on ART is recommended to educate on optimal adherence and motivate patients to disclose their status.
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Vaccine hesitancy among parents has led to re-emergence of vaccine preventable diseases. In Malaysia, measles cases had increased by three times in 2015 compared to previous year. Immunization coverage has always been above 95% since 2009. However, in 2014, Mumps-Measles-Rubella (MMR) coverage has a significant drop to 93.4%. The aim of the study was to identify predictors for inadequate knowledge and negative attitude towards childhood immunization among parents in Hulu Langat, Selangor. A cross sectional study design was conducted from January to July 2016 with760 respondents. Respondents were selected by cluster random sampling and a validatedself-administered questionnaire was used. The majority of respondents were female (70%), Malay (87%), employed (92%) and parents with tertiary education (99.7%). In this study, 12.8% parents have an inadequate knowledge on childhood immunization and 47.6% parents have a negative attitude towards childhood immunization. The predictors for inadequate knowledge on childhood immunizations were last child’s age of 2 years old or more (AOR=1.413 95% CI 0.28-0.69); parents without tertiary education (AOR=2.02 95% CI 1.15-3.54); parents withouteducational exposure on childhood immunization (AOR=2.87 95% CI 1.59-5.18) and parents who obtained information on childhood immunization from non-healthcare provider (AOR=2.66 95% CI 1.50-4.70). Predictors for negative attitude on childhood immunizations were being male (AOR=1.44 95% CI 1.04-2.01); parents without tertiary education (AOR=1.67 95% CI 1.04-2.68); household income of less than RM5000 (AOR=1.85 95% CI 1.28-2.67) and unsatisfactory religious belief (AOR=2.76 95% CI 2.03-3.75). Therefore, these predictors should be considered in any health intervention on childhood immunizations for parents in Malaysia.
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The maternal health status of Orang Asli women in Malaysia was noted to be lower as compared to other groups of population in the country. This study aimed to determine the level of knowledge, attitude and practice on antenatal care, which is a vital component of maternal health among the Orang Asli women in three Orang Asli villages in Jempol District, Negeri Sembilan. All women aged between 15 to 49 years old who had at least one antenatal experience were interviewed using a structured, pretested questionnaire. A total of 104 women were interviewed. Among them, 92.3% admitted attending antenatal clinic during their previous pregnancies while only 48.1% came early for their first check-up. About 70% of the women had history of home delivery and 44.2% had experienced at least one high risk pregnancy before. Study revealed that 44.2% (95% CI, 34.7 – 53.7%) of the women have good knowledge regarding antenatal care while 53.8% (95% CI, 44.3 – 63.1%) of them noted to have positive attitude regarding antenatal care. However, result showed that the level of knowledge regarding the importance of early antenatal care, screening test and complications of diabetes and hypertension in pregnancy were poor. In conclusion, the rate of home delivery and late antenatal booking was still high among the Orang Asli women and it is significantly associated with their attitude regarding antenatal care. These findings can be used to plan a customized health intervention program aiming to improve the maternal health practices and eventually improve the health status of the Orang Asli women.
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This paper explores the relationship between household wealth and nutritional status of pre-school children in Bangladesh using the nationally representative 2007 Bangladesh Demographic and Health Survey data. Chronic malnutrition was measured by z-score of height-for-age and the effect of household wealth on adverse childhood growth rate was assessed by multivariate logistic regression analyses. Overall, 43% of the children were stunted. The multivariate binary logistic regression analysis yielded significantly increased risk of stunting among the poorest (OR=2.26, 95% CI=1.77-2.89) as compared to the richest. The multivariate multinomial logistic regression produced elevated risk of moderate stunting (OR=1.98, 95% CI=1.50-2.61) and severe stunting (OR=2.88, 95% CI=2.00-4.14) of children in the poorest category compared to their richest counterparts. Children’s age, duration of breastfeeding, mother’s education, body mass index, mother’s working status and place of region were also identified as important determinants of children’s nutritional status. The findings suggest that apart from poverty reduction, maternal education, and strengthening of child and maternal health care services are important to improve health and nutritional status of the children.