This dissertation research utilizes anthropological methods to determine the degree to which the signs and symptoms female caregivers identify as causes of acute respiratory infections (ARIs) in under-fives in rural Ecuador correspond with Western biomedical categories. By employing both a semi-structured medical history questionnaire and more open-ended ethnographic methods such as in-depth informant interviews and focus group research, the researcher identifies the factors which determine timely health care-seeking behaviors of female caregivers in this case study. Economic factors such as the cost of medications and lost work hours were determined to be the primary financial obstacles for timely health care-seeking. Other barriers included limited and inconsistent hours at the health centers and transportation issues. Families of lower socioeconomic status were also more likely to have children suffering particular respiratory ailments. Childhood respiratory illness was identified as an outcome of poverty, which had the potential to reproduce itself through the negative effect of illness on household income. However, the research determined that there was an overall lack of recognition of the biomedical signs and symptoms of serious lower respiratory infections regardless of socioeconomic status. The model of ethnomedicine supports the finding that compliance with timely health care-seeking is limited without collaboration between healthcare professionals and communities to work towards beneficial and achievable goals that are joined by a common purpose. By understanding local cultural beliefs towards ARIs, healthcare professionals are in a better position to: (1) assess the accuracy or inaccuracy of ethnomedical beliefs and determine if there is a conflict in symptom recognition and care-seeking behavior with the biomedical model; (2) determine culturally-appropriate interventions or recommendations to address the health problems of the commu nity and identify barriers; and (3) work with existing community resources in order to foster effective health communication. This research finds that public health messages regarding ARIs be informed by ethnomedical knowledge of home treatments and beliefs. Moreover, health centers need to adhere to regular hours of operation and increase staff capacity to better meet the needs of their clients.

Over the course of the twentieth century, the quality, quantity and accessibility of health care services in Nicaragua were remarkably altered in accordance with the agendas of stakeholders in the national government and providers of "development aid", many of whose objectives were as much or more political as they were humanitarian. Much of the international health literature has focused on sociocultural factors that impact health care seeking, yet little research has been conducted on the political economic dimensions. This dissertation examines how sociocultural factors, political economy and social relations interacted in health care seeking decision-making among 50 poor and lower-middle-income households in Nicaragua, a country with high rates of poverty, child morbidity and child mortality. Attending to the ways that global and national policies were experienced in a local setting, the study provides an in-depth analysis of health care services in a country that has undergone three major regime changes within the last 25 years. How did the ideology of each regime influence health care, and how did the state influence both health staff and the lay population, especially with regards to people's expectations and understandings of the allocation of responsibility for health?The data indicate that health care services have significantly worsened during the recent years of neoliberal-oriented governance, concordant with an increase in economic insecurity. In conjunction with these macro-level processes, conditions of poverty have undermined people's ability to maintain longstanding reciprocal exchange relations and health care responsibilities. In ideology and praxis, the struggle between an ethos of solidarity and cooperation, versus one of individual competition and self-preservation, was engaged on a daily basis within and across extended households of kin, as well as between and among health care seekers and practitioners. Local level efforts to make up for the gap in government responsibility were limited precisely because the policies implemented by the government and international bodies undermined them. Neither the state nor civil society currently possesses the capacity to meet the basic health needs of the majority of Nicaraguans. For communities to thrive, the state must restore its safety net of health and other basic services.

Objectives:  A qualitative study to explore the perceptions and ideas of women at community level in Uganda, about factors influencing their health care-seeking behaviour when symptoms that could indicate pulmonary tuberculosis. To let the women identify barriers to health care-seeking and to let them present ideas how to overcome barriers. Method:  Focus Group Discussions (72 informants) and In Depth Interviews (19 informants) were conducted in rural Uganda with women of reproductive age. For triangulation purposes discussions and interviews also included health care providers, traditional healers and a few men. Main Results: The data showed a wide range of health care-seeking behaviours including no action at all, self-treatment using traditional herbs or western medicines, consulting traditional healers and consulting various formal or informal healthcare facilities. The data also identified many barriers that could prevent women from getting a proper diagnosis, including lack of financial resources, lack of power, male supremacy in decision-making, lack of knowledge, perceived corruption in healthcare facilities, fear of stigma and this fear heavily boosted by the idea that PTB equates HIV/AIDS. Conclusion: These data support the idea that successfully fighting PTB among Ugandan women and increasing case finding, demands recognition that tuberculosis is a multifaceted disease: economical, social, psychological and medical. Therefore, approaches to eradicating tuberculosis must target different sectors and reach all levels of society / <p>ISBN 978-91-86739-19-5</p>

<p>The negative effect of poor oral health on quality of life and financial implication of work days lost as a result of dental pain can be accepted as a rationale for inclusion of oral health in the primary health care (PHC) package for South Africa. The norms of the PHC package for oral health services are to expose at least 50% of primary schools to organized school preventive programmes and to ensure basic coverage of everybody in the catchment areas. Currently these norms are not adequately fulfilled in Randfontein. The purpose of this study was to gather information that can be used to improve oral health services in Randfontein. The aim of the study was to gain an understanding of the factors that influence the choice of oral health care seeking behaviour as perceived&nbsp / by residents in different contexts and to use these perceptions to inform appropriate health planning strategies and implementation of measures that can improve health promotion in Randfontein. This qualitative study explored oral health care seeking behaviour. The study population comprised all residents of Randfontein above seventeen years old who had visited the oral health section in the Randfontein Primary Health Care (PHC) Facility. There were two focus group discussions (FGDs) from each of three separate residential areas namely Mohlakeng with&nbsp / mainly black residents, Toekomsrus with mainly coloured race residents and from town which is a predominantly Caucasian race area. Data collected was analysed during the data collection stage and thereafter until they made sense to the researcher. To strengthen validity, the accuracy of the interpretation of what respondents said was confirmed with them. Analysed themes were&nbsp / coded and categorized to enable the key researcher to interpret them for final reporting. Appropriate ethical procedures were followed. The findings were that although all focus groups preferred&nbsp / allopathic oral health care seeking, various barriers existed. The study concluded that there should be adequate oral health education and promotion, effectivecommunication and an expansion of these services to Toekomsrus, where they do not exist. Perceptions on factors influencing oral health seeking by Randfontein residents&nbsp / </p>

<p>The negative effect of poor oral health on quality of life and financial implication of work days lost as a result of dental pain can be accepted as a rationale for inclusion of oral health in the primary health care (PHC) package for South Africa. The norms of the PHC package for oral health services are to expose at least 50% of primary schools to organized school preventive programmes and to ensure basic coverage of everybody in the catchment areas. Currently these norms are not adequately fulfilled in Randfontein. The purpose of this study was to gather information that can be used to improve oral health services in Randfontein. The aim of the study was to gain an understanding of the factors that influence the choice of oral health care seeking behaviour as perceived&nbsp / by residents in different contexts and to use these perceptions to inform appropriate health planning strategies and implementation of measures that can improve health promotion in Randfontein. This qualitative study explored oral health care seeking behaviour. The study population comprised all residents of Randfontein above seventeen years old who had visited the oral health section in the Randfontein Primary Health Care (PHC) Facility. There were two focus group discussions (FGDs) from each of three separate residential areas namely Mohlakeng with&nbsp / mainly black residents, Toekomsrus with mainly coloured race residents and from town which is a predominantly Caucasian race area. Data collected was analysed during the data collection stage and thereafter until they made sense to the researcher. To strengthen validity, the accuracy of the interpretation of what respondents said was confirmed with them. Analysed themes were&nbsp / coded and categorized to enable the key researcher to interpret them for final reporting. Appropriate ethical procedures were followed. The findings were that although all focus groups preferred&nbsp / allopathic oral health care seeking, various barriers existed. The study concluded that there should be adequate oral health education and promotion, effectivecommunication and an expansion of these services to Toekomsrus, where they do not exist. Perceptions on factors influencing oral health seeking by Randfontein residents&nbsp / </p>

Magister Public Health - MPH / The negative effect of poor oral health on quality of life and financial implication of work days lost as a result of dental pain can be accepted as a rationale for inclusion of oral health in the primary health care (PHC) package for South Africa. The norms of the PHC package for oral health services are to expose at least 50% of primary schools to organized school preventive programmes and to ensure basic coverage of everybody in the catchment areas. Currently these norms are not adequately fulfilled in Randfontein. The purpose of this study was to gather information that can be used to improve oral health services in Randfontein. The aim of the study was to gain an understanding of the factors that influence the choice of oral health care seeking behaviour as perceived by residents in different contexts and to use these perceptions to inform appropriate health planning strategies and implementation of measures that can improve health promotion in Randfontein. This qualitative study explored oral health care seeking behaviour. The study population comprised all residents of Randfontein above seventeen years old who had visited the oral health section in the Randfontein Primary Health Care (PHC) Facility. There were two focus group discussions (FGDs) from each of three separate residential areas namely Mohlakeng with mainly black residents, Toekomsrus with mainly coloured race residents and from town which is a predominantly Caucasian race area. Data collected was analysed during the data collection stage and thereafter until they made sense to the researcher. To strengthen validity, the accuracy of the interpretation of what respondents said was confirmed with them. Analysed themes were coded and categorized to enable the key researcher to interpret them for final reporting. Appropriate ethical procedures were followed. The findings were that although all focus groups preferred allopathic oral health care seeking, various barriers existed. The study concluded that there should be adequate oral health education and promotion, effectivecommunication and an expansion of these services to Toekomsrus, where they do not exist. Perceptions on factors influencing oral health seeking by Randfontein residents. / South Africa

The aim of the study on which this thesis is based was to gain an understanding of the life situation of street children in Kenya and to investigate how caring institutions care for these children.  A reflexive ethnographic approach was used to facilitate entry into the children’s sub-culture and the work contexts of the caregivers to better understand how the children live on the streets and how the caregivers work with the children. A fundamental aim of the research was to develop interventions to care; one of the reasons why we also used the interpretive description approach. Method and data source triangulation was used. Field notes, tape, video, and photography were used to record the data.  Participant observation, group discussions, individual interviews, home visits, key informant interviews, participatory workshops and clinical findings were used for data collection in Studies I and II.  In addition to observation, interviews were conducted with caregivers for study III, while written narratives from learners attending adult education developed and implemented during the research period provided data for study IV.  Study I indicated that food, shelter and education were the main concerns for the children and that they had strong social bonds and used support networks as a survival strategy.  Study II provided a deeper understanding of the street culture, revealing how the boys are organised, patterns of substance use, home spaces in the streets and networks of support. The boys indicated that they wanted to leave the streets but opposed being moved to existing institutions of care. A group home was therefore developed in collaboration with members of the category “begging boys”.  Study III indicated how the caregivers’ interactions with the children were crucial in children’s decisions to leave the streets, to be initiated into residential care, undergo rehabilitation and to be reintegrated into society.  Caregivers who attempted to use participatory approaches and took time to establish rapport were more successful with the children.  Study IV suggested that the composition of learners, course content grounded on research, caregivers’ reflections and discursive role of researchers and facilitators, all contributed to adult learning that transformed the learners’ perspectives and practice.

No description available.

PURPOSE: The main aim of this study was to systematically assess women’s maternal health care seeking behaviour and its determinants in Addis Ababa, Ethiopia. DESIGN: A quantitative and cross-sectional community based study was the selected methodology for this study. METHOD: Data was collected using structured questionnaire administered to 903 women aged 15-49 years through a stratified two-stage cluster sampling technique. Binary and multinomial logistic regression models were employed to identify predictors of adequacy of antenatal care and delivery care. RESULTS: Most of the women (97.9%) visited health care facilities at least once for antenatal care follow up. About 86.5% of them had at least four visits during their last pregnancy; and only 51.1% started their first antenatal visit early. Further, only about one out of five of the antenatal care attendees received sufficient content of antenatal care services. Consequently, only about one out of ten women received overall adequate antenatal care mainly due to inadequate use of the basic components of antenatal services. Most of the women delivered in public health care institutions (76.3%) despite the general doubts about the quality of services in these facilities. Women of better socioeconomic status preferred to give birth at private health care facilities. Caesarean section delivery rate in Addis Ababa (19.1%) is higher than the maximum WHO recommended rate (15.0%); particularly among the non-slum residents (27.2%); clients of private health care facilities (41.1%); currently married women (20.6%); women with secondary (22.2%) and tertiary (33.6%) level of education; and women who belong to the highest wealth quintile (28.2%). The majority (65.8%) of the caesarean section clients were not informed about the consequences of caesarean section delivery and about 9.0% of the caesarean section births had no medical indication. CONCLUSION: Disparities in maternal health care utilisation between the socio-economic groups was evident, requiring urgent attention from policy makers and other stakeholders to enable Ethiopia to meet its millennium development goal 5. Improving the quality of antenatal care in public health facilities which are the main provider of health care services to the majority of the Ethiopian population is urgent. The increase in the rate of caesarean section beyond the World Health Organization recommended upper limit has to be taken seriously. / Health Studies / D. Litt.. et Phil. (Health Studies)

PURPOSE: The main aim of this study was to systematically assess women’s maternal health care seeking behaviour and its determinants in Addis Ababa, Ethiopia. DESIGN: A quantitative and cross-sectional community based study was the selected methodology for this study. METHOD: Data was collected using structured questionnaire administered to 903 women aged 15-49 years through a stratified two-stage cluster sampling technique. Binary and multinomial logistic regression models were employed to identify predictors of adequacy of antenatal care and delivery care. RESULTS: Most of the women (97.9%) visited health care facilities at least once for antenatal care follow up. About 86.5% of them had at least four visits during their last pregnancy; and only 51.1% started their first antenatal visit early. Further, only about one out of five of the antenatal care attendees received sufficient content of antenatal care services. Consequently, only about one out of ten women received overall adequate antenatal care mainly due to inadequate use of the basic components of antenatal services. Most of the women delivered in public health care institutions (76.3%) despite the general doubts about the quality of services in these facilities. Women of better socioeconomic status preferred to give birth at private health care facilities. Caesarean section delivery rate in Addis Ababa (19.1%) is higher than the maximum WHO recommended rate (15.0%); particularly among the non-slum residents (27.2%); clients of private health care facilities (41.1%); currently married women (20.6%); women with secondary (22.2%) and tertiary (33.6%) level of education; and women who belong to the highest wealth quintile (28.2%). The majority (65.8%) of the caesarean section clients were not informed about the consequences of caesarean section delivery and about 9.0% of the caesarean section births had no medical indication. CONCLUSION: Disparities in maternal health care utilisation between the socio-economic groups was evident, requiring urgent attention from policy makers and other stakeholders to enable Ethiopia to meet its millennium development goal 5. Improving the quality of antenatal care in public health facilities which are the main provider of health care services to the majority of the Ethiopian population is urgent. The increase in the rate of caesarean section beyond the World Health Organization recommended upper limit has to be taken seriously. / Health Studies / D. Litt. et Phil. (Health Studies)