<p>Background: Globally, neonatal mortality (i.e. deaths occurring during the first month of life) accounts for 44% of the 11 million infants that die every year (Lawn, Cousens &amp / Zupan, 2005). Early&nbsp / detection of illness and referral of mothers and infants during the peri-natal period to higher levels of care can lead to substantial reductions in maternal and child mortality in developing&nbsp / countries. Establishing effective referral systems from the community to health facilities can be achieved through greater utilization of community health workers and improved health seeking&nbsp / behaviour. Study design: The Good Start Saving Newborn Lives study being conducted in Umlazi, KwaZulu-Natal, is a community randomized trial to assess the effect of an integrated home&nbsp / visit package delivered to mothers during pregnancy and post delivery on uptake of PMTCT interventions and appropriate newborn care practices. The home visit package is delivered by community health workers in fifteen intervention clusters. Control clusters receive routine health facility antenatal and postpartum care. For any identified danger signs during a home visit,&nbsp / community health workers write a referral and if necessary refer infants to a local clinic or hospital. The aim of this study was to assess the effectiveness of this referral system by describing&nbsp / community health worker referral completion rates as well as health-care seeking practices and perceptions of mothers. A cross- sectional survey was undertaken using a structured&nbsp / questionnaire with all mothers who had been referred to a clinic or hospital by a community health worker since the start of the Good Start Saving Newborn Lives Trial. Data collection: Informed consent was obtained from willing participants. Interviews were conducted by a trained research assistant in the mothers&rsquo / home or at the study&nbsp / offices. Road to Health Cards were reviewed to confirm referral completion. Data was collected by means of a cell phone (mobile researcher software) and the database was later transferred to Epi-info and STATA IC 11 for analysis.&nbsp / Descriptive analysis was&nbsp / conducted so as to establish associations between explanatory factors and referral completion and to describe referral processes experienced by caregivers. Significant&nbsp / associations between categorical variables were assessed using chi square tests and continuous variables using analysis of variance. Results: A total of 2423 women were&nbsp / enrolled in the SNL study and 148 had received a referral for a sick infant by a CHW by June 2010. The majority (95%) of infants were referred only once during the time of enrolment, the&nbsp / highest number of which occurred within&nbsp / the first 4 weeks of life (62%) with 22% of these being between birth and 2 weeks of age. Almost all mothers (95%) completed the referral by taking&nbsp / their child to a health facility. Difficulty in breathing and rash accounted for the highest number of referrals (26% and 19% respectively). None of the six mothers who did not complete referral recognised any danger signs in their infants. In only 16% of cases did a health worker give written feedback on the outcome of the referral to the referring CHW.&nbsp / Conclusion: This study found&nbsp / high compliance with referrals for sick infants by community health workers in Umlazi. This supports the current primary health care re-engineering process being undertaken by the South&nbsp / African National Department of Health (SANDOH) which will involve the establishment of family health worker teams&nbsp / including community health workers. A key function of these workers will&nbsp / be to conduct antenatal and postnatal visits to women in their homes and to identify and refer ill children. Failure of mothers to identify danger signs in the infant was associated with&nbsp / non-completion of referral. This highlights the need for thorough counseling of mothers during the antenatal and early postnatal period on neonatal danger signs which can be reinforced by&nbsp / community health workers. Most of the referrals in this study were&nbsp / neonates which strengthens the need for home visit packages delivered by community health workers during the antenatal&nbsp / and post-natal period as currently planned by the South African National Department of Health.Recommendations: This study supports the current plans of the Department of Health for greater involvement of CHWs in Primary Health Care. Attention should be given to improving communication between health facilities and CHWs to ensure continuity of care and greater&nbsp / realization of a team approach to PHC.</p>

Pulmonary Tuberculosis (TB) is a significant cause of morbidity in Uganda. TB control in the Ugandan district of Butaleja remains poor, characterised by TB case detection and cure rates below national targets. A qualitative exploratory and descriptive study was conducted to identify factors associated with health-seeking behaviour of TB patients in Butaleja district; with an aim to present recommendations for promoting positive health-seeking behaviour amongst the patients. Data was collected through individual in-depth interviews with seven diagnosed TB patients and analysed using Creswell’s (2009:186) analytic spiral steps. The findings revealed three major themes, namely; the nature of health-seeking behaviour, factors associated with the health-seeking behaviour and advice to others experiencing similar symptoms. The health-seeking behaviour of participants was generally poor, characterised by delay in seeking proper medical treatment for TB. Health system, individual and social factors contributed to poor health-seeking behaviour among the participants. The study recommends health system and community interventions targeted at individuals to improve health-seeking behaviour for Pulmonary TB / Health Studies / M.A. (Public Health)

Magister Public Health - MPH / Background: Globally, neonatal mortality (i.e. deaths occurring during the first month of life) accounts for 44% of the 11 million infants that die every year (Lawn, Cousens Zupan, 2005). Early detection of illness and referral of mothers and infants during the peri-natal period to higher levels of care can lead to substantial reductions in maternal and child mortality in developing countries. Establishing effective referral systems from the community to health facilities can be achieved through greater utilization of community health workers and improved health seeking behaviour. Study design: The Good Start Saving Newborn Lives study being conducted in Umlazi, KwaZulu-Natal, is a community randomized trial to assess the effect of an integrated home visit package delivered to mothers during pregnancy and post delivery on uptake of PMTCT interventions and appropriate newborn care practices. The home visit package is delivered by community health workers in fifteen intervention clusters. Control clusters receive routine health facility antenatal and postpartum care. For any identified danger signs during a home visit, community health workers write a referral and if necessary refer infants to a local clinic or hospital. The aim of this study was to assess the effectiveness of this referral system by describing community health worker referral completion rates as well as health-care seeking practices and perceptions of mothers. A cross- sectional survey was undertaken using a structured questionnaire with all mothers who had been referred to a clinic or hospital by a community health worker since the start of the Good Start Saving Newborn Lives Trial. Data collection: Informed consent was obtained from willing participants. Interviews were conducted by a trained research assistant in the mothers home or at the study offices. Road to Health Cards were reviewed to confirm referral completion. Data was collected by means of a cell phone (mobile researcher software) and the database was later transferred to Epi-info and STATA IC 11 for analysis. Descriptive analysis was conducted so as to establish associations between explanatory factors and referral completion and to describe referral processes experienced by caregivers. Significant associations between categorical variables were assessed using chi square tests and continuous variables using analysis of variance. Results: A total of 2423 women were enrolled in the SNL study and 148 had received a referral for a sick infant by a CHW by June 2010. The majority (95%) of infants were referred only once during the time of enrolment, the highest number of which occurred within the first 4 weeks of life (62%) with 22% of these being between birth and 2 weeks of age. Almost all mothers (95%) completed the referral by taking their child to a health facility. Difficulty in breathing and rash accounted for the highest number of referrals (26% and 19% respectively). None of the six mothers who did not complete referral recognised any danger signs in their infants. In only 16% of cases did a health worker give written feedback on the outcome of the referral to the referring CHW. Conclusion: This study found high compliance with referrals for sick infants by community health workers in Umlazi. This supports the current primary health care re-engineering process being undertaken by the South African National Department of Health (SANDOH) which will involve the establishment of family health worker teams including community health workers. A key function of these workers will be to conduct antenatal and postnatal visits to women in their homes and to identify and refer ill children. Failure of mothers to identify danger signs in the infant was associated with non-completion of referral. This highlights the need for thorough counseling of mothers during the antenatal and early postnatal period on neonatal danger signs which can be reinforced by community health workers. Most of the referrals in this study were neonates which strengthens the need for home visit packages delivered by community health workers during the antenatal and post-natal period as currently planned by the South African National Department of Health.Recommendations: This study supports the current plans of the Department of Health for greater involvement of CHWs in Primary Health Care. Attention should be given to improving communication between health facilities and CHWs to ensure continuity of care and greater realization of a team approach to PHC. / South Africa

Thesis (M. A. (Nursing Science)) -- University of Limpopo, 2019 / Introduction: Health seeking behaviours are explained as a dynamic interaction of cognitive, behavioural and effective elements, focusing on the attitudes and beliefs of individuals preceded by a decision-making process that is governed by individual or community norms within the primary health level context to explain and predict health behaviours. Aim: The purpose of this study was to describe factors contributing to health seeking behaviour of patients at Sister Mashiteng Clinic, Nkangala District of Steve Tshwete Local Municipality, Mpumalanga Province. Methodology: A qualitative, explorative, descriptive and contextual research design was followed in this study. A non- probability purposive sampling was used to select 15 patients who voluntarily agreed to participate in this study. The researcher conducted semi-structured, one-on-one interviews which were tape recorded and transcribed. Data collection was done and analysed using the Tesch’s inductive, descriptive coding technique. Results: Four themes emerged, namely, explanations related to the factors contributing to health seeking behaviour; reasons towards missing scheduled appointments behaviours; views about health seeking behaviours related to services provided at the clinics; related/existing health believes amongst patients. To ensure the trustworthiness of the research data, Lincoln and Guba’s framework, as outlined by Polit and Beck (2010), was adhered to throughout the study. Conclusion: Findings of the study revealed that the factors contributing to health seeking behaviour in Steve Tshwete clinics are behaviours that were linked to prescribed treatment, test and treat during consultation in the clinic, socio-economic background, behaviours of missing scheduled appoints or treatment, health seeking behaviour due to avoidance of running out of treatment, lack of reliable transport blamed for health seeking, patients trust of private doctors and family influence.

Of the 3.5 million persons infected with chronic HCV in the United States, the African American population is the largest racial group with chronic HCV. Disparities in access to care and treatment involve a complex set of individual, interpersonal, socioeconomic, and environmental factors that influence the course of HCV infection in the African American population, resulting in poorer outcomes and survival. Drawing upon both the theory of reasoned action and the theory of planned behavior, this study was conducted to determine whether the seeking of health care by HCV-positive African Americans and the responses of health care providers to HCV-positive African Americans had improved since 2008 following the introduction of new treatment options, as compared to other HCV-positive racial/ethnic groups, using secondary data analyses with survey datasets from the National Health and Nutrition Examination Survey, 2005-2012. Using chi-square test of difference and logistic regression analyses, the study did not identify a statistically significant relationship between health care seeking behavior and responses from health care providers for HCV-positive African Americans before (2005-2008) and after (2009-2012) the introduction of new treatment options as compared to other HCV-positive racial/ethnic groups. Given the ongoing development of new and improved drugs to treat HCV infection, further research might focus on the HCV-infected population as a whole to ascertain whether differences exist as compared to earlier therapies before 2013. This study may drive social change within the health care community by raising awareness of the risks of HCV infection resulting in less provider bias and the introduction of resources into the African American and underserved communities that will improve outcomes and reduce barriers to care.

PhD / Department of Public Health / See the attached abstract

The purpose of the study is to investigate lived experiences of refugees when accessing healthcare services in Pretoria, South Africa. A qualitative phenomenological research approach was followed which assisted in exploring and describing the day-to-day lives of refugees living in Pretoria regarding their health outcomes. Face-to-face interviews were conducted on purposively selected participants, representing refugees from different African countries ranging from age 27 to 58 years. Collected data were transcribed, coded, and relevant themes were extracted and analysed by employing Colaizzi's seven-step analysis framework. Main findings demonstrated that the public healthcare services accessed by refugees, compared to private healthcare services, can be described as mostly dysfunctional. Also, healthcare providers from public healthcare services are often hostile towards refugees of African descent. Failure to speak a local language, unofficial documentation as viewed by a healthcare provider on duty, being a foreigner, and failure to pay undue consultation fees led to refugees being denied access to healthcare or receiving negative treatment in the public healthcare sector. Recommendations for programmes to promote human rights and refugee awareness in healthcare facilities could subsequently contribute to alleviating complications around access to healthcare services, which would denote improved health outcomes for the refugees. / Health Studies / M. P. H. (Health Studies)

No description available.

Global maternal and newborn mortality have made much progress in recent years. Forexample, newborn deaths have almost halved since the 1990s, and the global maternalmortality rate (MMR) has been reduced by nearly 38 percent during the same period.Maternal and newborn deaths are still unacceptably high, and an estimated 2.7 millionnewborns die worldwide each year, most of them in low-income countries (Lawn et al.,2016). The Mayuge District in rural southeastern Uganda is a district experiencing significantmaternal and newborn health difficulties. According to Willey et al. (2018), 438 expectantmothers die from childbirth-related complications per 100,000 live births, and 23 newbornsdie per 1000 live births in the Mayuge District. The 3-delays model is used in researchconcerning maternal and newborn health worldwide and works to simplify and categorize thecauses of poor maternal and newborn health (Bergström et al., 2009). The delays aredescribed as follows; (1) delay in seeking care; (2) delay in reaching a healthcare facility; and(3) delay in receiving appropriate care.This study focuses on the first delay, which is the delay in seeking healthcare, and examinesif stigma and social identity affect health-seeking behavior in the district. Other identifiedfactors affecting health-seeking behavior will be presented during the study and compiledalongside possible recommended interventions to combat the issues. According to the resultspresented in this study, stigmatization, culture, tradition, and misinformation are evidentdrivers for the delay in seeking healthcare in the Mayuge district in Uganda. This studyfurther reveals that inherited social identity could be identified as traditional aspects andaffect people's health-seeking behavior. It is shown that the district suffers from poormaternal and newborn health caused by all of the three delays presented in this study.However, the results of this study show that the first delay is one of the least researched andthat the local government gives little to no attention to the delay in seeking healthcare in thedistrict.

This research was stimulated by an indication that members of the Africa Gospel Church do not utilise professional health care services optimally, probably due to religious reasons. This may also be the result of registered nurses&#8217; inability to render culture congruent care. To render culture congruent care, nurses require knowledge of the belief system and the health seeking behaviours of the church members. The qualitative research investigated the religious beliefs and health seeking behaviours of members of the Africa Gospel Church in Francistown, Botswana. An exploratory ethnonursing research method was applied. Semi-structured interviews were held with two purposively selected samples. Qualitative data analysis was done using computer software to reduce data and interpret the research results. The study indicated that members utilise the Church structure for health care purposes and seek health care mainly from priests and prophets. / Advanced Nursing Sciences / M.A. (Nursing Science)