Diss. (sammanfattning) Stockholm : Karol. inst., 2001. / Härtill 6 uppsatser.

Abstract The aim of this cross-sectional controlled study was to determine frequent attenders' chronic diseases and their reasons for encounter in primary health care. Furthermore, the study aimed to determine the associations of social, psychological and family factors with frequent attendance in a Finnish health centre. Patients who made eight or more annual visits to physicians in the health centre during one year were defined as frequent attenders (FA). All the FAs during 1994 (N=304) and 304 randomly selected age- and sex-matched controls constituted the study population. The data were collected from annual statistics, medical records and postal questionnaires. Over one third of the study population was interviewed. International Classification of Primary Care (ICPC) was used to determine the reasons for encounter and Symptom Checklist - 36 (SCL-36) to assess the psychological distress. Toronto Alexithymia Scale -20 (TAS-20) was used as a measure of alexithymia and Whiteley Index (WI) to determine hypochondriacal beliefs. The results showed that 4.7% of the whole population aged 15 years or older in Oulainen were FAs. They accounted for 23.5% of all visits made within the respective age group. The mean age of the FAs was 49.8 years. Over two thirds of them were female. The FAs had lower basic education and occupational status than the controls. The FAs visited physicians in the health centre mostly for reasons related to the musculoskeletal, respiratory and digestive systems. There appeared to be more chronic diseases among the FAs than among the controls. The FAs had over three times more mental disorders than the controls. The interviewed FAs had significantly more psychological distress, somatization and hypochondriacal beliefs than the controls. The risk of frequent attendance was higher in the older family life cycle phases than in the younger family life cycle phases. Multivariate analyses showed chronic somatic disease and hypochondriacal beliefs to be risk factors for frequent attendance. Concurrence of somatization and hypochondriacal beliefs increased the risk to be a FA. As a conclusion, the results emphasize the need to consider the FAs' own bodily concerns expressed as hypochondriacal beliefs when managing them. Furthermore, the study implicates a need to integrate the biomedical, psychological and social dimensions in the care of FAs in primary health care.

The purpose of this study was to determine factors influencing skilled delivery service utilisation in order to develop strategies to improve utilisation of skilled birth attendance service in North West Ethiopia. The objectives were to explore and describe the perceptions and experiences of the community regarding skilled utilisation of the birth attendance service; explore reasons for non-utilisation of skilled birth attendance service; asses the health system experience of provision of skilled birth attendance service; and formulate strategies to improve utilisation of skilled birth attendance service. The study employed a qualitative, descriptive, and explorative research design to address the research questions formulated by the researcher. The study used focus group discussion guide to obtain information from pregnant women and women who gave birth recently. Furthermore, the study used an interview guide to gather information from health extension workers, midwives, health centre heads, district health office technical experts and heads. It also employed and inductive thematic analysis approach to analyse the qualitative data. The study further used the Atlas ti version 7 for the data analysis. The steps followed for the analysis were data immersion, coding, displaying, reduction, and interpretation. Overall, nine themes emerged from the analysis of the data. Consequently, the researcher used the findings of the study to develop strategies to improve the utilisation of skilled birth attendance service. / Health Studies / D. Litt. et Phil. (Health Studies)

Text in Afrikaans / Summaries in Afrikaans and English / VIGS is 'n gesondheidsprobleem wat 'n impak uitoefen op alle gebiede in die samelewing. Voorkoming is die enigste vorm van bekamping. As gevolg hiervan, word VIGS-voorkoming binne die funksies van primere gesondheidsorg geplaas. Die persoon wat die funksies van primere gesondheidsorg uitoefen, is die gemeenskapsgesondheidswerker. Binne hierdie raamwerk is die terme primere gesondheidsorg, gemeenskapsgesondheidswerker en VIGS bespreek en die onderlinge interaksie is aangetoon. Die opleiding wat die gemeenskapsgesondheidswerker op VIGS-gebied ondergaan, is meegemaak. Die prioriteite wat op nasionale, provinsiale en plaaslike vlak bestaan is deur middel van onderhoude nagevors. Die effektiwiteit van die VIGS-voorkomingsboodskap soos oorgedra deur die gemeenskapsgesondheidswerker is tydens 'n inligtingsessie van hoerskoolleerlinge bepaal. Gevolgtrekkings en aanbevelings is in elk van bogenoemde gevalle gemaak. VIGS-voorkomingsinisiatiewe is nog in die kinderskoene in Suid-Afrika, maar het 'n belangrike rol te speel. / AIDS is a health problem that impacts on all societal spheres. Prevention is the only form of combat. Therefore, AIDS prevention falls within the functions of primary health care. The person performing these functions is the community health worker. Within this framework the terms primary health care, community health worker and AIDS were discussed and their interrelatedness illustrated. A session during which community health workers received training in aspects of AIDS was attended. Priorities existing at national, provincial and local levels were researched through interviews. The effectiveness of the community health worker in spreading the AIDS prevention message was determined during an information session for secondary school pupils. Conclusions and recommendations were made in each of these cases. AIDS prevention initiatives are still in its infancy in South Africa, but has an important role to play. / Health Studies / M.A. (Ontwikkelingsadministrasie)

Text in Afrikaans / Summaries in Afrikaans and English / VIGS is 'n gesondheidsprobleem wat 'n impak uitoefen op alle gebiede in die samelewing. Voorkoming is die enigste vorm van bekamping. As gevolg hiervan, word VIGS-voorkoming binne die funksies van primere gesondheidsorg geplaas. Die persoon wat die funksies van primere gesondheidsorg uitoefen, is die gemeenskapsgesondheidswerker. Binne hierdie raamwerk is die terme primere gesondheidsorg, gemeenskapsgesondheidswerker en VIGS bespreek en die onderlinge interaksie is aangetoon. Die opleiding wat die gemeenskapsgesondheidswerker op VIGS-gebied ondergaan, is meegemaak. Die prioriteite wat op nasionale, provinsiale en plaaslike vlak bestaan is deur middel van onderhoude nagevors. Die effektiwiteit van die VIGS-voorkomingsboodskap soos oorgedra deur die gemeenskapsgesondheidswerker is tydens 'n inligtingsessie van hoerskoolleerlinge bepaal. Gevolgtrekkings en aanbevelings is in elk van bogenoemde gevalle gemaak. VIGS-voorkomingsinisiatiewe is nog in die kinderskoene in Suid-Afrika, maar het 'n belangrike rol te speel. / AIDS is a health problem that impacts on all societal spheres. Prevention is the only form of combat. Therefore, AIDS prevention falls within the functions of primary health care. The person performing these functions is the community health worker. Within this framework the terms primary health care, community health worker and AIDS were discussed and their interrelatedness illustrated. A session during which community health workers received training in aspects of AIDS was attended. Priorities existing at national, provincial and local levels were researched through interviews. The effectiveness of the community health worker in spreading the AIDS prevention message was determined during an information session for secondary school pupils. Conclusions and recommendations were made in each of these cases. AIDS prevention initiatives are still in its infancy in South Africa, but has an important role to play. / Health Studies / M.A. (Ontwikkelingsadministrasie)

Text in English / Malaria is endemic throughout Uganda and the leading cause of morbidity and mortality. Malaria causes complications in 80.0% of all pregnancies in Uganda. This study attempted to identify factors that influence pregnant women’s utilisation of anti-malaria services in the Buikwe district of Uganda. These factors were contextualised within the Social Learning Theory’s major concepts. The target populations comprised pregnant women attending antenatal clinics (phase 1) and midwives providing antenatal services (phase 2) at 16 clinics in the Buikwe district of Uganda during the data collection phase of the study. Structured interviews were conducted with a sample of 400 randomly selected pregnant women and with the accessible population of 40 midwives. Pregnant women, who had progressed beyond primary school level education, were more likely to take intermittent preventive treatment (IPT) drugs and to use long lasting insecticide treated nets (LLINs) to prevent malaria. Pregnant women were more likely to implement malaria-preventive actions if they lived within five kilometres of clinics, were satisfied with available health services, were knowledgeable about the malaria preventive measures and had used IPT during previous pregnancies. Pregnant women who implemented one malaria-preventive action were likely to implement other actions as well (Pearson’s correlation coefficient was 0.65; p<0.05). Midwives’ provision of malaria-preventive services to pregnant women were influenced by the availability of IPT drugs, accessibility of safe drinking water, frequency of giving health education to pregnant women, cooperation with village health teams, malaria-related in-service training, midwives’ education level and experience. Although 97.9% of the pregnant women had taken IPT and 84.2% of those who had received LLINs, utilised these nets, malaria prevention during pregnancy could be improved. All pregnant women should attend antenatal clinics at least four times during each pregnancy, commencing during the first trimester of pregnancy to receive adequate health education and prenatal services, including IPT and LLINs. All midwives should receive malaria-related in-service training. Regular audits of midwives’ records should identify and address strengths and weaknesses related to the prevention and management of malaria during pregnancy. Such actions could enhance the prevention and management of malaria, estimated to affect 80% of pregnant women in Uganda. / Health Studies / D. Litt. et Phil. (Health Studies)