Substance use disorders (SUDs) result in numerous negative outcomes, with only a minority of those with a SUD ever seeking treatment. A more complete understanding is needed of the factors that impact treatment enrollment. The purpose of this analysis was to identify individual and social network correlates of treatment enrollment for substance use disorders among a sample of 330 persons who used drugs and resided in Baltimore, MD between 2014 and 2017. Models were built using multivariable logistic regression and sub-analyses were performed among subsets of individuals based on type of drug use and available treatment options for that type. In the overall sample, the number of network members currently enrolled in drug treatment was positively associated with treatment enrollment, with an increase in odds of treatment enrollment of 122% for each additional network member currently enrolled in treatment (95% CI: 1.48, 3.34). The number of network members who used heroin, cocaine, and/or crack was not associated with treatment enrollment (OR: 1.07, 95% CI: 0.88, 1.37); however, the number of network members who used drugs and provided emotional, financial, instrumental or material support (i.e., network members he/she could talk to, socialize with, who pitched in to help him/her, who were willing to provide financial support, or who he/she stayed with) reduced the odds of treatment enrollment by 38% for each additional person who used drugs in the could support network (95% CI: 0.42, 0.92). It appears to be the nature, rather than the number, of ties with other people who use drugs (PWUD) that impacts an individual’s probability of treatment enrollment. The implication may be that, rather than encouraging PWUD to distance themselves from all PWUD in their network, that they focus on fostering close relationships with sober individuals, and that they attempt to transfer sources of emotional and financial support to people who do not use drugs. / 2021-02-28T00:00:00Z

Includes bibliographical references (leaves 111-116). / This research project was undertaken with the primary objective of determining whether there are differential household health care utilization patterns between rural and urban areas in Zambia and what factors, if any, are responsible for such spatial variations. The factors considered in this study include: the gender of the household head, age of individual household members, religious affiliation of the household, the marital status of the household head, the size of the household, the educational status of the household head, the household head's employment status, and the socio-economic status of the household. The data was collected using a household health survey with questionnaires administered to the household head. A total of 660 households (3,150 persons) were sampled, 320 households (1,696 persons) in Chipata District and 340 households (1,454 persons) in Ndola District. The data included information on socio-economic and demographic factors that have been regularly considered in the theoretical literature and empirical evidence as impacting upon household and individual decision-making when it comes to utilization of both formal and informal care. A multinomial logistic regression model was used to analyse the data quantitatively in Stata® Version 8.0 software. Close to a quarter ofthe overall sample admitted to suffering an illness or injury in the 4-week period preceding the interview. Self-care at the household level was the most frequently reported type of care chosen for minor and moderate illnesses or injuries (35.80 percent). Bivariate analysis and the multinomial logistic regression results indicate that the variables considered not only produce differential effects on household health care utilization patterns in both districts but also that the effects are different depending on location of the household. The results from our sample analyses show that household religious affiliation (Christianity) is negatively associated with formal health care utilization in the urban area while the age of the individual increases the household's utilization of formal and informal care, and the gender of the household head (female), hislher marital status, educational attainment, and employment status all have a positive impact on formal health care use in the rural area.

Vaccines are one of the greatest public health interventions in modern times. Their development has drastically reduced the global burden of infectious disease. However, rising vaccine hesitancy is contributing to the reemergence of vaccine-preventable diseases. The reasons for vaccine hesitancy are complex and diverse. This paper aims to explore the reasons why vaccine hesitancy persists. These reasons include safety concerns, spread of misinformation, religion and culture, awareness and knowledge, personal and philosophical beliefs, and the patient-provider relationship. There is no single solution to addressing vaccine hesitancy. Providers play an important role in influencing an individual’s decisions about vaccination. Motivational interviewing and other communication strategies are helpful in establishing trust with hesitant individuals. Monitoring online information can elucidate trends of public sentiment about vaccines and prepare health officials for spikes in vaccine hesitancy. Policy-based interventions may cause more harm than good. Community-based solutions are particularly effective in regions where resources are scarce. Vaccine hesitancy has repercussions for containing novel infectious diseases.

Background: Optimal breastfeeding promotes child health and survival globally. Pro-breastfeeding HIV infant feeding policy changes in 2010, and the roll-out of universal maternal anti-retroviral therapy (ART) since 2013, have created an opportunity for re-establishment of breastfeeding among HIV exposed infants in resource-limited settings. Yet data are limited on breastfeeding practices under these policies. This study aimed to evaluate breastfeeding practices and predictors of breastfeeding cessation among women living with HIV (WLHIV) receiving universal ART, and a comparator group of HIV-negative (HIV-) women in Cape Town, South Africa. Methodology: This secondary data analysis used deidentified data from two parallel, prospective cohort studies conducted at the Gugulethu Midwife and Obstetric Unit between 2013 and 2017; the unit is certified as Baby-Friendly. Utilizing the same research staff, measurement tools and procedures, the studies followed pregnant women (HIV-; and WLHIV initiating universal ART) through delivery. HIVexposed infants received nevirapine and co-trimoxazole prophylaxis. At the early neonatal visit (± 7 days), breastfeeding mother-infant pairs were eligible to continue follow-up (visits at 6 weeks; 3, 6, 9, 12 months). At each study visit, trained field workers administered 24-hour recall questionnaires to assess infant feeding and asked about changes in feeding practices since the preceding visit. Exclusive breastfeeding (EBF) was defined as feeding infants no other food or drink other than breastmilk, except for medicines, vitamins and minerals. Breast feeding (BF) was censored at last visit with reported BF. We used Cox proportional hazards regression to assess factors associated with cessation of exclusive and all breastfeeding among HIV-negative children of both groups of women (HIV-exposed uninfected, HEU and HIV-unexposed, HU children), expressed as crude (HR) or adjusted hazard ratios (aHR). Results: Overall, 872 breastfeeding mother-infant pairs (HEU, n=461; HU, n=411) contributed 925 person-years of follow-up. All WLHIV initiated ART in pregnancy (at ART initiation, median HIV viral load 3.97 log10 copies/mL; median CD4 cell count, 354 cells/uL); 352/461 (76%) of WLHIV had viral load < 1 hour; overall, 788/867, 91%) was more common among HU than HEU infants (95% vs 87%, p<0.0001). Among infants who ever received EBF (754/872, 86%), median EBF duration was 1.4 (0.2-3.1) months. HEU vs HU infants were more likely to ever EBF (91% vs 81%, p <0.0001), with longer durations of EBF (median 1.5 vs 1.4 months, p=0.01; HR for EBF cessation, 0.78 [95% CI 0.67-0.9]). The overall median duration of any breastfeeding was 6.0 (IQR 1.5-12.0) months, with earlier cessation among HEU (median 3.9 months) than HU infants (median 9.0 months); HR for BF cessation 1.87 (95% CI 1.56-2.24). Lactation issues (for example cracked nipples or engorgement) were common in the first 6 weeks postpartum (reported by 143 of 872, 16%), with greater risk among WLHIV than HIV- women (20% vs 12%, p=0.003). Lactation problems (vs none reported) were associated with increased relative hazard for EBF cessation among both HEU (HR 1.48, 95% CI 1.13- 1.96) and HU infants (HR 1.63, 95% CI 1.17-2.26); and for BF cessation among HEU infants (HR 2.45, 95% CI 1.85-3.24). Study limitations include reliance on maternal recall, and inability to assess exact date of breastfeeding cessation. Conclusion: Breastfeeding practices remain poor among both WLHIV and HIV- women, despite probreastfeeding HIV policy changes. An alarmingly high proportion of WLHIV reported lactation problems including cracked nipples. These data highlight an urgent need for lactation support among peri-urban women in our setting, especially those living with HIV, both to improve overall breastfeeding practices to maximize child health and to prevent breastmilk-associated transmission of HIV.

No description available.

BACKGROUND: Many low and middle-income countries are experiencing colliding epidemics of chronic infectious (ID) and non-communicable diseases (NCD). As a result, the prevalence of multiple morbidities (MM) is rising. METHODS: We conducted a retrospective study to describe the epidemiology of MM in a primary care clinic in Khayelitsha, an informal township in Cape Town. Adults with at least one of HIV, tuberculosis (TB), diabetes (T2DM), and hypertension (HPT) were identified between Sept 2012-May 2013 on electronic databases. Using unique patient identifiers, drugs prescribed across all facilities in the province were linked to each patient and each drug class assigned a condition. RESULTS: These 4 diseases accounted for 45% of all prescription visits. Among 14364 chronic disease patients, HPT was the most common morbidity (65%). 22.6% of patients had MM, with an increasing prevalence with age, and a high prevalence among younger antiretroviral therapy (ART) patients (26% in 18-35yr and 30% in 36-45 year age groups). HPT and T2DM prevalence was higher a mong younger ART patients with MM compared to those not on ART. Of note, 37% of TB MM patients were also on treatment for H PT and 12% were on treatment for T2DM respectively, and 86% of T2DM patients were on HPT treatment. CONCLUSION: We highlight the co-existence of multiple ID and NCD. This presents both challenges (increasing complexity and the impact on health services, providers and patients), and opportunities for chronic diseases screening in a population linked to care. It also necessitates re-thinking of models of health care delivery and calls for policy interventions that integrate and coordinate management of co-morbid chronic diseases.

Includes bibliographical references (leaves 87-94). / The aim of this research was to establish an inventory of rugby-related spinal cord injuries that occurred in South Africa between 1980 and July 2007, and to expand the knowledge of the risk factors. Analysis of this information may lead to improved prevention, treatment and rehabilitation of spinal cord injuries among rugby players at all levels.

Includes bibliographical references (leaves 83-92). / One major challenge facing the international development community is how to finance and provide health care for the large informal sector in low and middle income countries. This is as a result of the inability of the traditional tax systems in most of these countries to generate the needed revenue to help meet the health needs of the citizens. In recent times, many countries in developing countries are increasingly depending on Community Based Insurance Schemes (CBHIS) as an alternative health care financing mechanism. In Ghana. the universal tax funded system of health care introduced in 1957 soon alter independence could not be sustained because of economic recession in the 1970's and 1980's forcing the government to introduce user fees in all public health institutions. User fees resulted in a decline in utilization of health services especially the poor and vulnerable group. This situation forced many communities to set up CBHIS meant to cover user fees charged at the health facilities. The success of some of these schemes and the fact that many Ghanaians do not have insurance cover led the government to introduce a National Health Insurance Scheme (NHIS) which is mandatory for all citizens. The law mandates all formal sector workers to contribute part of their social security contribution to the National Health Insurance Fund as premium, thus making it compulsory for them. Those in the informal sector are however required to voluntarily pay directly into their district schemes. Also, even though a proposal has been made to exempt the poor, no mechanism has been determined to identify poor households for subsidy. This study sought to undertake a critical evaluation of the role of CBHIS under the NHIS in extending health care coverage to the large informal sector (who are about 70% of the active labour force) in Ghana. Specifically, the study sought to determine factors that affect enrolment, to determine a practical mechanism to identify the poor and to gain an understanding of how other countries have increased health insurance coverage.

The aim of this study was to assess whether the quality of the RTI data collected by the South African Police Service (SAPS) and mortuaries was sufficient for determining the burden of RTIs in the Western Cape province, and for implementing and monitoring road safety interventions.

Background: People with disabilities in impoverished rural areas of South Africa struggle to access healthcare, despite the right to health established by the Constitution and the United Nations Convention on the Rights of Persons with Disabilities. Health system challenges and structural conditions of poverty impact this group in specific ways, with implications for households and communities that are not well understood. To date, health systems research and design have largely omitted disability considerations. Primary health care (PHC) calls for community engagement with health systems, to voice local needs, influence service provision, and hold providers to account. However, current models of community engagement rely on certain political, social and economic conditions, which are not present for rural people with disabilities in South Africa. Purpose: This study sought to understand the existing engagement between rural people with disabilities and healthcare workers in the PHC interface, and thus to theorise how this could be strengthened for more responsive and equitable services.