The reality of embedded drug purchasing practices: Understanding the sociocultural and economic aspects of the use of medicines in Bangladesh.

BACKGROUND: Purchasing drugs with or without prescription from retail drug shops is common practice in Bangladesh. However, what actually takes place between the drug seller and customer during the transaction is under-researched. This study explores the drug purchasing practices which underlie the socio-cultural and economic aspects of a Bangladeshi city. METHODS: Adopting ethnographic methods, we conducted thirty in-depth interviews (IDIs) with customers, patients, and sales assistants, and ten key informant interviews (KIIs) with drug sellers, experienced sales assistants and pharmaceutical company representatives. Thirty hours were spent observing drug sellers' and buyers' conversations and interactions for medicine. A total of 40 heterogeneous participants were purposively selected from three drug stores. Transcribed data were coded, and analyzed thematically. RESULTS: We found through thematic analysis that some individuals visited the drug store with fixed ideas about the name, brand, and dose of the drugs they wanted. Among the 30 IDIs participants, most individuals come without any preconceived ideas, describe their symptoms, and negotiate purchases with the expectation of quick remedies. Cultural practices of buying medicines in full or partial course of doses, with or without prescription, trust in sellers, and positive previous experiences of medications shape the drug purchasing behavior, regardless of any preconceived ideas concerning brand name, and dose. Few customers (n = 7) sought drugs by trade name, but most drug sellers often offered a generic substitute because selling non-brand drugs is more profitable. Notably, many of the clients (n = 13) bought drugs through installment payments and with loans. CONCLUSION: Community people choose and purchase the most necessary medicines in a self-medicated way from shortly trained drug sellers that can harm individuals' health and reduce the effectiveness of medication. In addition, the results of buying medicine through installments and loans suggest further research on the financial burden of consumers' purchasing behavior. Policymakers, regulators, and healthcare professionals might implicate the study findings to deliver practical information on the rational use of medicines to sellers and customers.

Associations Between Spousal Relationship, Husband Involvement, and Postpartum Depression Among Postpartum Mothers in West Java, Indonesia.

INTRODUCTION: Indonesia is actively promoting husband involvement in maternal health care, since it has been claimed to impact the wellbeing of mothers. This study aims to investigate the extent to which spousal relationship, husband involvement, and maternal health behavior affect postpartum depression among Indonesian mothers. METHOD: A survey was carried out among 336 postpartum mothers who received maternal care in 27 independent midwifery clinics in 7 regions of West Java Province, Indonesia. The measurement model of husband involvement comprising 4 dimensions, namely maternity care engagement, instrumental support, emotional support, and informational support were developed and validated using confirmatory factor analysis. The Quality of Marriage Index (QMI) and the Edinburgh Postnatal Depression Scale (EPDS) were also validated and used to measure spousal relationship and postpartum depressive symptoms. A structural equation model was specified to examine the association between spousal relationship, husband involvement, maternal healthy behavior, and postpartum depression. RESULTS: The study confirms the assumption that the quality of the spousal relationship could determine husband's involvement during pregnancy, childbirth, and postpartum (γ = .60, P < .001), eventually leading to better maternal healthy behavior (γ = .015, P < .001) and a decrease in postpartum depressive symptoms among mothers (γ = -.21, P < .001). CONCLUSIONS: The study results suggest the needs to promote comprehensive husband involvement to enhance the wellbeing of mothers. This can be achieved through couple interventions at the community level and the inclusion of a supportive role for husbands in the maternal and childcare guidebook offered during ANC visits.

Transnational Mobility and Utilization of Health Services in Northern Thailand: Implications and Challenges for Border Public Health Facilities.

INTRODUCTION/OBJECTIVE: Transnational populations from the Association of Southeast Asian Nations are crossing borders regardless of whether their status is legal or undocumented, to receive health services in the border regions of Thailand. The implications and challenges of transnational mobility and the utilization of public health facilities in Thailand's border regions are therefore investigated in this study. METHODS: Four public health facilities were selected, located in 2 economically-active border areas in Northern Thailand: Mae Sai-Tachileik at the Thailand-Myanmar border and Chiang Saen-Ton Phueng at the Thailand-Lao PDR border. Qualitative data were obtained from in-depth interviews with 8 medical and non-medical hospital staff responsible for implementing facility-level policies and providing health services for the transnational population. RESULTS: Five themes were identified through analysis of the implications and challenges for transnational mobility and the utilization of public health facilities under study: contextual determinants of illness in specific border areas; uncompensated care as opposed to financial management in serving the transnational population; health service opportunities for the transnational population; cross-border collaboration on public health; and the remaining challenges of transnational mobility in border regions. CONCLUSION: Conventional content analysis with interpretative induction of in-depth interview data offers recommendations for improving the capacity of border health facilities to reduce the burden placed upon them to provide services to the transnational population.

Correction: Parents' knowledge, beliefs, and acceptance of the HPV vaccination in relation to their socio-demographics and religious beliefs: A cross-sectional study in Thailand.

[This corrects the article DOI: 10.1371/journal.pone.0193054.].

Parents' knowledge, beliefs, and acceptance of the HPV vaccination in relation to their socio-demographics and religious beliefs: A cross-sectional study in Thailand.

Thailand has one of the world's highest prevalence of cervical cancer, mainly caused by the human papillomavirus (HPV). HPV infections can successfully be prevented by vaccination, which is available at a cost but not yet implemented in the national vaccination program. Parents play a critical role in deciding whether to vaccinate their child against HPV. Thus, the aim was to examine the association between parents' knowledge, beliefs, and acceptance of the HPV vaccination for their daughters, considering their socio-demographics and religious beliefs. A cross-sectional design was used among three schools in Thailand: Nakorn Phatom province (suburban) and Bangkok (urban). Parents of 9-12-year-old daughters completed the questionnaires, guided by the Health Belief Model. In total, 359 parents completed the questionnaires; of those, 301 were included in the final analyses. The ordinary least squares (OLS) regression analysis showed that background knowledge of HPV and the HPV vaccine was positively related to knowledge of HPV and cervical cancer. For beliefs, knowledge was positively associated with susceptibility (i.e., parents' perceived risk of an HPV infection/ related disease), severity, and benefit. However, knowledge was not significantly related to barriers. For acceptance, higher susceptibility and benefit were related to higher acceptance, and greater knowledge was associated with higher acceptance. Thus, we found associations between parents' knowledge, beliefs, and acceptance of the HPV vaccination for their daughters, considering their socio-demographics and religious beliefs. Parents, who reported religion as important, as opposed to those who did not, were more favorable toward the HPV vaccination. Four out of ten mothers had never undergone a cervical cancer screening, but most had accepted previous childhood vaccinations for their daughters. The overall acceptance of the vaccine was high, and we believe our results are promising for future implementation of the HPV vaccination in the national childhood vaccination program in Thailand.

Witnessing violence among high school students in Thailand.

The goal of this study was to explore the levels of witnessing violence among Thai youths and to examine whether a Western model of witnessing violence that relates to personal and family characteristics, peer relationships, own violence, violence in the family, violence in the school, and in the community, is appropriate for the Thai reality. The random sample consisted of 2,897 youths: 1,107 (38.2%) males and 1,722 (59.4%) females. Results indicated that witnessing violence rates among the Thai youths are high, but in general, quite similar to those reported in the west. The most frequently witnessed violent act was hitting and punching in school. Peer characteristics and their advice were the most related factor to witnessing violence followed by own violence activities, violence in the family, and the surrounding subsystems, supporting the similarities of the Thai reality to the Western one. No significant differences were indicated between the rural and inner-city settings. The results were interpreted in light of the cultural characteristics of Thailand.

Youth attitudes toward dating violence in Thailand.

This study assessed the occurrences and intensity of psychological, physical, and sexual attitudes toward dating violence among Thai youths, and examined possible variables related to the formation of these attitudes.The random sample consisted of 1,296 male and female adolescents from high school, vocational school, and out-of-school groups. Thai youths in general reported attitudes that were supportive of dating violence. The variables more closely related to attitudes toward dating violence were personal variables. Peer influence, partner relationships, and family characteristics were related to higher support for dating violence. Females reported higher endorsement of dating violence than males. The theoretical and practical implications of the results are discussed, and recommendations for policy makers are drawn.