The Patient-Provider Relationship and Antenatal Care Uptake at two Referral Hospitals in Malawi: A Qualitative Study

Background.Approximately 90% of Malawian women attend antenatal care at least once during their pregnancies; however; most mothers first present during months five and six and do not adhere to the World Health Organization's recommended four visits. The objective of this study was to explore the role the patient-provider relationship has on antenatal care uptake.Methods. A qualitative study; consisting of interviews with 20 urban pregnant mothers and eight health workers; was conducted from September to December 2014. Two large tertiary care hospitals in the Central and Southern regions of Malawi were selected as study sites. Results.Several factors influenced antenatal care attendance. Significant barriers reported included the patient-provider relationship; clinic wait times; family and friend support; distance from home to the clinic; transportation; cost; and number of visits. The patient-provider relationship appears to have a large impact on antenatal clinic participation. Mothers indicated that health workers often mistreat or demean them during visits. Additionally; health workers revealed that; due to staff shortages; patients often do not receive the care they deserve. Conclusions.The results of this study suggest that; in addition to other factors; healthcare provider attitudes influence antenatal clinic attendance. Improving the patient-provider relationship may increase antenatal clinic attendance and decrease complications during pregnancy. Professional development opportunities and quality improvement programmes would help improve patient care and health outcomes while the continued staff shortages in the country are addressed

Quality of parent-child relationship and adolescent HIV risk behaviour in St. Maarten.

The highest incidence rates of HIV/AIDS in the Caribbean are recorded in heterosexual and youth populations. With sparse prevention and intervention programmes in place, there is a pressing need to address the HIV/AIDS risk of youth. The objective of this analysis was to describe the extent of youth risk behaviour in St. Maarten and explore the relationship between quality of parental-child relationship and adolescent HIV risk behaviours. The sample consisted of 1,078 students (age range 14-18, mean 15.6 (s.d. 1.7). The data were collected by self-report survey in the Spring of 2001 in the classrooms of all seven secondary schools in St. Maarten. The survey instrument included demographic information, and used questions derived from the Center for Disease Control's (CDC) Youth Risk Behavior Survey (YRBS) to assess health risk behaviour prevalence, including tobacco, alcohol, and drug use, and sexual activity. The survey also asked youth to rate their relationship with their parents. Analysis showed a relatively high rate of risk behaviour in this school population. Multi-variate analysis showed that a 'great' relationship with both parents, as perceived by the student, was significantly associated with lower rates of tobacco and alcohol use as well as lower rates of sexual activity.