It has been reported that Asian people have negative views of mental illness, including beliefs that it is incurable and shameful. Asian people also tend to attribute causes of mental disorders to factors less susceptible to personal influence such as supernatural factors, and are likely to have an external health locus of control which reflects beliefs that health outcomes are a product of external factors such as luck. In the present study, each of the above constructs were compared between American and Asian students. In addition, the above constructs were used to predict self-report of utilization of various treatment modalities. Four inventories were developed to assess the above constructs and treatment preferences. Reliability and validity of the new measures were examined. Results revealed that Asian students were more likely than American students to identify psychological disorder as shameful and its sufferers as socially untrustworthy and dangerous. Asian students were also more likely to attribute the causes of psychological disorder to supernatural factors than American students, and were more likely to seek folk medicine remedies for psychological disorder than were American students were. Both American and Asian students endorsed family care as the most preferable treatment approach, followed by psychological intervention, medical intervention, folk medicine intervention, and no treatment. An internal mental health locus of control predicted participants' willingness to seek no treatment. Among Asian students, beliefs in the untrustworthiness of the mentally ill predicted their willingness to seek folk medicine treatment. Attribution of psychological disorder to supernatural causes predicted their unwillingness to seek medical treatment. Among American students, an internal mental health locus of control predicted participants' willingness to seek no treatment. Attribution of supernatural causes and an internal mental health locus of control predicted their willingness to seek folk medicine treatment. A belief that mentally ill people were untrustworthy predicted a preference for medical interventions. / Master of Science

Master of Public Health - MPH / Introduction:Highest-risk malaria areas in South Africa share borders with Mozambique, Swaziland and Zimbabwe. Ongoing migration between these neighbouring areas impacts on malaria control interventions. For example, 30% of the adult population in Bushbuckridge originate from Mozambique. Despite these dynamics, no studies were found which investigated knowledge,attitudes and behaviours towards malaria in Bushbuckridge. Methods:This study was undertaken as a descriptive cross-sectional survey. A field-piloted structured questionnaire was administered to 602 randomly selected households, where only one household member was interviewed. Interviewees were heads of households, but in their absence, responsible adults above 18 years were included.Results:Of 602 respondents, 93% (n=559, 95% CI: 90.4 – 94.7%) had heard about malaria, mainly from health facilities (29%, n=175) and radios (20%,n=119). Most respondents correctly associated malaria with mosquito bites. There were no differences in knowledge of the causes of malaria between males and females, whereas age and educational level influenced malaria knowledge.Younger and more educated respondents were more knowledgeable than their older and less educated counterparts. Despite 91% of respondents (n=546, 95% CI: 88.0 – 92.8%) knowing that malaria can kill if untreated; only 48% could identify one or two symptoms of malaria. Most (99%, n=595, 95% CI: 97.5 – 99.5%) of the respondents would seek treatment at health facilities,82% (n=488) of whom would do so within 24 hours of onset of malaria symptoms.Discussion and conclusion : Most respondents showed a fair amount of knowledge on the causes of malaria, but not enough people were able to correctly identify the key symptoms of malaria. Health facility and radio were the main sources of malaria information. Most respondents sought treatment at health care facilities, contrary to most African countries where treatment is first sought at non-public health facilities.Word count: 288

Introduction: Patients of specialized nicotine dependence clinics are hypothesized to form a distinct subpopulation of smokers due to the features associated with treatment seeking. The aim of the study was to describe this subpopulation of smokers and compare it to smokers in general population Material and methods: A chart review of 796 outpatients attending a specialized nicotine dependence clinic, located in Toronto, Ontario, Canada was performed. Client smoking patterns and sociodemographic characteristics were compared to smokers in the general population using two Ontario surveys – the Ontario Tobacco Survey (n = 898) and the Centre for Addiction and Mental Health Monitor (n = 457). Results: Smokers who seek treatment tend to smoke more and be more heavily addicted. They were older, had longer history of smoking and greater number of unsuccessful quit attempts, both assisted and unassisted. They reported lower education and income, had less social support and were likely to live with other smokers. Conclusions: Smokers who seek treatment in specialized centers differ from the smokers in general population on several important characteristics. These same characteristics are associated with lower chances for successful smoking cessation and sustained abstinence and should be taken into consideration during clinical assessment and treatment planning.

The COVID-19 pandemic affected regular health care for patients with chronic diseases. However, the impact of the pandemic on primary care for patients with coronary artery disease (CAD) who are enrolled in a structured disease management program (DMP) in Germany is not clear. We investigated whether the pandemic affected primary care and health outcomes of DMP-CAD patients (n = 750) by using a questionnaire assessing patients’ utilization of medical care, CAD symptoms, as well as health behavior and mental health since March 2020. We found that out of concern about getting infected with COVID-19, 9.1% of the patients did not consult a medical practitioner despite having CAD symptoms. Perceived own influence on infection risk was lower and anxiety was higher in these patients compared to symptomatic CAD patients who consulted a physician. Among the patients who reported chest pain lasting longer than 30 min, one third did not consult a medical practitioner subsequently. These patients were generally more worried about COVID-19. Patients with at least one worsening CAD symptom (chest pain, dyspnea, perspiration, or nausea without apparent reason) since the pandemic showed more depressive symptoms, higher anxiety scores, and were less likely to consult a doctor despite having CAD symptoms out of fear of infection. Our results provide evidence that the majority of patients received sufficient medical care during the COVID-19 pandemic in Germany. However, one in ten patients could be considered particularly at risk for medical undersupply and adverse health outcomes. The perceived infection risk with COVID-19 might have facilitated the decision not to consult a medical doctor.

The aim of this study was to describe mothers’ knowledge, attitudes and practices regarding malaria in children under five years old. A descriptive cross-sectional study design was used. A structured questionnaire was administered by face-to-face interviews during data collection. The study population of this research composed of mothers of children under five years old suffering from malaria in Thyolo district. Economic-demographic characteristics that were significantly associated with mothers’ knowledge were age (p=0.018), formal education (p=0.001), income (p=0.005), and type of a house (p=0.002). Sources of malaria information that were significantly associated with mothers’ knowledge included television (p=0.004), radio (p=o.005), and posters (p=o.00019). Treatment-seeking behaviour was significantly associated with education (p=0.017). Treatment prior to hospitalisation was significantly associated with mothers’ education (p=0.0001), number of children that passed away (p=0.015), distance to the health facility (p=0.013), lack of money (p=0.019), and time taken at the hospital to get treatment (p=0.016). Recommendations were made to improve mothers’ malaria knowledge for further research / Health Studies / M.A. (Public Health)

The aim of this study was to describe mothers’ knowledge, attitudes and practices regarding malaria in children under five years old. A descriptive cross-sectional study design was used. A structured questionnaire was administered by face-to-face interviews during data collection. The study population of this research composed of mothers of children under five years old suffering from malaria in Thyolo district. Economic-demographic characteristics that were significantly associated with mothers’ knowledge were age (p=0.018), formal education (p=0.001), income (p=0.005), and type of a house (p=0.002). Sources of malaria information that were significantly associated with mothers’ knowledge included television (p=0.004), radio (p=o.005), and posters (p=o.00019). Treatment-seeking behaviour was significantly associated with education (p=0.017). Treatment prior to hospitalisation was significantly associated with mothers’ education (p=0.0001), number of children that passed away (p=0.015), distance to the health facility (p=0.013), lack of money (p=0.019), and time taken at the hospital to get treatment (p=0.016). Recommendations were made to improve mothers’ malaria knowledge for further research / Health Studies / M.A. (Public Health)

Contexte. Le paludisme provoque annuellement le décès d’environ 25 000 enfants de moins de cinq ans au Burkina Faso. Afin d’améliorer un accès rapide à des traitements efficaces, les autorités burkinabées ont introduit en 2010 la prise en charge du paludisme par les agents de santé communautaires (ASC). Alors que son efficacité a été démontrée dans des études contrôlées, très peu d’études ont évalué cette stratégie implantée dans des conditions naturelles et à l’échelle nationale. Objectif. L’objectif central de cette thèse est d’évaluer, dans des conditions réelles d’implantation, les effets du programme burkinabé de prise en charge communautaire du paludisme sur le recours aux soins des enfants fébriles. Les objectifs spécifiques sont : (1) de sonder les perceptions des ASC à l’égard du programme et explorer les facteurs contextuels susceptibles d’affecter leur performance ; (2) d’estimer le recours aux ASC par les enfants fébriles et identifier ses déterminants ; (3) de mesurer, auprès des enfants fébriles, le changement des pratiques de recours aux soins induit par l’introduction d’une intervention concomitante – la gratuité des soins dans les centres de santé. Méthodes. L’étude a été conduite dans deux districts sanitaires similaires, Kaya et Zorgho. Le devis d’évaluation combine des volets qualitatifs et quantitatifs. Des entrevues ont été menées avec tous les ASC de la zone à l’étude (N=27). Des enquêtes ont été répétées annuellement entre 2011 et 2013 auprès de 3002 ménages sélectionnés aléatoirement. Les pratiques de recours aux soins de tous les enfants de moins de cinq ans ayant connu un récent épisode de maladie ont été étudiées (N2011=707 ; N2012=787 ; N2013=831). Résultats. Les résultats montrent que le recours aux ASC est très modeste en comparaison de précédentes études réalisées dans des milieux contrôlés. Des obstacles liés à l’implantation du programme de prise en charge communautaire du paludisme ont été identifiés ainsi qu’un défaut de faisabilité dans les milieux urbains. Enfin, l’efficacité du programme communautaire a été négativement affectée par l’introduction de la gratuité dans les centres de santé. Conclusion. La prise en charge communautaire du paludisme rencontre au Burkina Faso des obstacles importants de faisabilité et d’implantation qui compromettent son efficacité potentielle pour réduire la mortalité infantile. Le manque de coordination entre le programme et des interventions locales concomitantes peut générer des effets néfastes et inattendus. / Context. In Burkina Faso, malaria causes approximately 25,000 deaths every year in children under five. In 2010, national health authorities introduced case management of malaria by community health workers (CHWs) as a way to increase prompt access to effective treatments. While this strategy’s efficacy has been demonstrated in controlled studies, very few studies evaluated its effectiveness under real-world and nation-wide conditions of implementation. Objective. The overarching aim of this thesis is to evaluate the effects of the Burkinabè program on treatment-seeking practices in febrile children. The specific objectives are: (1) to examine CHWs’ perceptions and investigate the contextual factors likely to affect their performance; (2) to estimate the use of CHWs in febrile children and its determinants; (3) to evalauate changes in treatment-seeking practices induced by the introduction of a concomitant intervention – the removal of user fees at health centres. Methods. The study was conducted in two similar health districts, Kaya and Zorgho. The evaluation design integrates quantitative and qualitative components. Interviews were carried out with all CHWs in the study area (N=27). Surveys were repeated every year from 2011 to 2013 in 3002 randomly selected households. Treatment-seeking practices of all children with a recent sickness episode (N2011=707; N2012=787; N2013=831) were examined. Results. Results show that the use of CHWs is really low in comparison to previous controlled studies. Feasibility issues in urban areas and barriers to implementation of the community case management of malaria programme were identified. Moreover, its effectiveness in rural areas was challenged by the removal of user fees at health centres. Conclusion. In Burkina Faso, community case management of malaria faces serious challenges of feasibility and implentation. These challenges compromise the programme’s potential to reduce child morbidity and mortality. The lack of integration between the programme and local concomitant interventions can generate unpredicted adverse effects.