A study of 185 clients with sexually transmitted infections (STIs) attending an STI clinic in Kumasi, Ghana found that 64% delayed seeking treatment for more than 4 weeks after symptoms appeared. 61% had previously sought treatment elsewhere before coming to the clinic. 80% had unprotected sex while symptomatic. The document discusses factors that influence healthcare seeking behaviors for STIs, including long wait times, stigma, lack of privacy, and attitudes of healthcare providers. It also examines sexual behaviors among STI patients, noting that most engage in unprotected sex during symptomatic periods. Understanding these healthcare seeking patterns and behaviors can help develop more effective STI prevention and control programs.
Levels of Utilization and Socio - Economic Factors Influencing Adherence to U...inventionjournals
The paper intends to assess the level of utilization and socio-economic factors influencing adherence to utilization of Anti Retroviral Therapy (ART) for People Living with HIV/AIDS in Dodoma Municipality and Kongwa District in Tanzania. Documentary review, interview and Focus Group Discussion were used in collecting data. A total of 140 respondents (99 PLWHIV/AIDS and 41 key informants) from four hospitals, two health centers and one dispensary were selected and interviewed as representatives for the purpose of this study. Quantitative data were collected and analyzed by using SPSS version 16 software. The study revealed 100% of PLWHIV/AIDS used ART drugs in Dodoma General Hospital, Kongwa Hospital, Mkoka Health Center and Makole Health Center while 40% in St. Gemma Hospital. Also the study indicated there were high dropout from utilization of ART drugs among PLWHIV/AIDS, 60% in Mirembe hospital, (50%) in Mkoka health center and (44%) in St. Gemma hospital as compared to the rest health centers and hospitals. The drop out caused by ART drugs side effects such as vomiting (25.1%), frequently sickness (19.9%) and decrease in CD 4 (11.2%). Lastly the study revealed four main socio-economic factors influencing adherence to utilization of ART services among PLHIV/AIDS including lack of employment support (66.7 %,) lack of confidentiality (50 %,) patient’s preference to traditional medicines (30%) and cultural belief (29.3%). The study recommends all PLWHIV/AIDS with side effects should report their cases to health centers and hospitals because not all side effects require a change of drugs or discontinuation, PLWHIV/AIDS should be assisted by Government and Non-Government Organizations and family members to secure soft loans that will enable them to establish income generation activities, education on patients confidentiality should be provided to services providers in hospitals and health centers
FACTORS ASSOCIATED WITH HUMAN IMMUNODEFICIENCY VIRUS COUNSELLING AND TESTING ...Razak Mohammed Gyasi
Since 2003, the HIV Voluntary Counselling and Testing (VCT) has been identified as one of the key strategies in the HIV/AIDS prevention, control and care programmes in Ghana. However, utilization of this service is low among Ghanaian youth. This study examined predictors associated with VCT utilization among youth in Ghana. This study utilized quantitative and qualitative data in a cross-sectional survey in three sub-metropolitan areas in Kumasi. Using a multi-variate regression, evidence from 120 respondents showed potential factors associated with VCT utilization. The qualitative data were subjected to a content analysis through direct quotes. The results suggest that less than 30% of the youth had ever tested for HIV through VC. Women were more likely to avail themselves for counselling testing than men. Psychological and emotional trauma experienced by the seropositive, lack of confidentiality, proximity to VCT sites, HIV-related stigma inter alia, were found to be strongly associated with HIV VCT in the study prefecture. VCT utilization among the youth in Ghana was low and affected by HIV/AIDS-related stigma and residence. In order to increase VCT acceptability, HIV/AIDS prevention and control programs in the country should focus on reducing HIV/AIDS-related stigma.
Levels of Utilization and Socio - Economic Factors Influencing Adherence to U...inventionjournals
The paper intends to assess the level of utilization and socio-economic factors influencing adherence to utilization of Anti Retroviral Therapy (ART) for People Living with HIV/AIDS in Dodoma Municipality and Kongwa District in Tanzania. Documentary review, interview and Focus Group Discussion were used in collecting data. A total of 140 respondents (99 PLWHIV/AIDS and 41 key informants) from four hospitals, two health centers and one dispensary were selected and interviewed as representatives for the purpose of this study. Quantitative data were collected and analyzed by using SPSS version 16 software. The study revealed 100% of PLWHIV/AIDS used ART drugs in Dodoma General Hospital, Kongwa Hospital, Mkoka Health Center and Makole Health Center while 40% in St. Gemma Hospital. Also the study indicated there were high dropout from utilization of ART drugs among PLWHIV/AIDS, 60% in Mirembe hospital, (50%) in Mkoka health center and (44%) in St. Gemma hospital as compared to the rest health centers and hospitals. The drop out caused by ART drugs side effects such as vomiting (25.1%), frequently sickness (19.9%) and decrease in CD 4 (11.2%). Lastly the study revealed four main socio-economic factors influencing adherence to utilization of ART services among PLHIV/AIDS including lack of employment support (66.7 %,) lack of confidentiality (50 %,) patient’s preference to traditional medicines (30%) and cultural belief (29.3%). The study recommends all PLWHIV/AIDS with side effects should report their cases to health centers and hospitals because not all side effects require a change of drugs or discontinuation, PLWHIV/AIDS should be assisted by Government and Non-Government Organizations and family members to secure soft loans that will enable them to establish income generation activities, education on patients confidentiality should be provided to services providers in hospitals and health centers
FACTORS ASSOCIATED WITH HUMAN IMMUNODEFICIENCY VIRUS COUNSELLING AND TESTING ...Razak Mohammed Gyasi
Since 2003, the HIV Voluntary Counselling and Testing (VCT) has been identified as one of the key strategies in the HIV/AIDS prevention, control and care programmes in Ghana. However, utilization of this service is low among Ghanaian youth. This study examined predictors associated with VCT utilization among youth in Ghana. This study utilized quantitative and qualitative data in a cross-sectional survey in three sub-metropolitan areas in Kumasi. Using a multi-variate regression, evidence from 120 respondents showed potential factors associated with VCT utilization. The qualitative data were subjected to a content analysis through direct quotes. The results suggest that less than 30% of the youth had ever tested for HIV through VC. Women were more likely to avail themselves for counselling testing than men. Psychological and emotional trauma experienced by the seropositive, lack of confidentiality, proximity to VCT sites, HIV-related stigma inter alia, were found to be strongly associated with HIV VCT in the study prefecture. VCT utilization among the youth in Ghana was low and affected by HIV/AIDS-related stigma and residence. In order to increase VCT acceptability, HIV/AIDS prevention and control programs in the country should focus on reducing HIV/AIDS-related stigma.
Abstract—Hepatitis B virus (HBV) infection is one of the major global public health problems with nearly 2 billion people infected worldwide. So this present study was planned to have information about socio-demographic characteristics of study subjects, level of knowledge about Hepatitis B and vaccination among adults. A cross-sectional, community-based study about hepatitis B knowledge and vaccination status among ethnic 1300 Kashmiri population aged 18 years and above was conducted. The study area was block Hazratbal of district Srinagar. There were 970 (74.6%) females and 330 (25.4%) males. Majority of our participants (54.7%) were in the age group of 21-40 years. Most of the participants were from urban areas(68%), currently married(66.8%), illiterate(64.8), members of joint family(59%) and belonging to socio-economic class II(67.2%). Regarding knowledge, only 10.2% subjects had heard of Hepatitis B before this study. Among them, 50 (37.6%) participants were aware of the modes of transmission of this disease. About the Hepatitis B vaccination, only 26 (2%) participants out of 1300 had ever received the vaccine. Keeping in view, the low level of knowledge about Hepatitis B in the general population, there is a need to organize health education campaigns targeting both health care workers as well as public, so that they adopt all possible measures to prevent the spread of this fatal infection.
Quality of life and its sociodemographic and clinicalpredictorsamong people o...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
Competition genomic medicine presentationResearchsio
Prepared By Roman Sharkar and Mir Tasfiq Alam. Both of them are students of the B.Pharm Program in Bangladesh. They prepared this ppt file from their choice of interest which is Genomic Medicine. Hope this will handly to the others who are interested in this topic !!
Malaria Control Strategies among Rural Dwellers in a Typical Nigerian Settingasclepiuspdfs
Malaria is a major public health problem in sub-Saharan African, including Nigeria, causing 63% of total outpatient attendance in health facilities, 30% under-five mortality, and 11% of maternal mortality. Malaria control practices remain a major strategy in the combat of this menace. Therefore, the aim of this study is to determine the malaria control strategies utilized among rural dwellers in the Ezza North local government area (LGA) of Ebonyi state.
Factors Influencing the Uptake of National Health Insurance Schemes among the...Premier Publishers
Purpose: Penetration of health insurance in the informal sector is very poor, this calls for upward scaling of successful interventions to remedy this situation given that health insurance increases access to healthcare services and improves financial risk protection. This study assessed the factors influencing uptake of national health insurance schemes among informal sector in Vihiga sub-county, Kenya.
Methods: Descriptive cross-sectional study design was used. The target population was the informal sector workers. A sample of 384 participants was selected by cluster and simple random sampling techniques. Data was collected using a semi-structured questionnaire. Descriptive statistics was summarized using tables, chi-square and bivariate logistic regression were used to test for associations (p<0.05).
Results: The study revealed that there was a significant influence of trust and knowledge of the health insurance scheme on the uptake of national health insurance (p < 0.05). The study further revealed that the attractiveness of the scheme had a big influence on the uptake of national health insurance
Conclusion: Trust and knowledge of the health insurance scheme had significant influence on uptake of national health insurance. Health Insurance Schemes should be designed in such a way that they attract informal sector workers and information regarding these schemes is disseminated to these people.
People Living with Human Immunodeficiency Virus in Hadhramout: Clinical Prese...asclepiuspdfs
The objective of the study was to determine the clinical features and outcome of patients living with human immunodeficiency virus (HIV) in Hadhramout and nearby governorates. Materials and Methods: This descriptive study was conducted in the antiretroviral therapy (ART) site at Ibn-Sina General Hospital, Mukalla, Hadhramout governorate. All 145 patients were enrolled in HIV treatment and care program from December 2008 to the end of December 2016 with confirmed HIV test. Data included all personal data, clinical staging, drugs taken, and outcomes. Patients were grouped according to the decades to five groups, ≤15 years, 16–30 years, 31–50 years, 51–70 years, and >70 years. Cases classify according to the antiretroviral drugs to ART group and Pre-ART group. The relevant data parameters were analyzed using SPSS statistical software version 21 and Excel 10. Results: A total of 145 cases, most adults (97.9%), males and females were104 (71.7%) and 41 (28.3%), respectively. Mean age was 36.46 years and 30–50 years the most affected age group (55.2%). Clinical Stages 3 and 4 were the common presentation in 73.8%, and most cases were from Mukalla city. Of the total cases, 74.5% were on ART 53.1 of them improved, pulmonary tuberculosis was found in 4 cases, and death cases were (18.5%), mostly due to late presentation and non-adherence, and mostly occurred in early 6 months of starting the ART. 37 patients were in a pre-treatment group (21.6%), where the mortality rate is 35.1%, mainly due to loss of follow-up. Conclusions: Most cases were adult males, young age and have had late presentation, where mortality is higher in the pre-treatment group due to loss of follow-up and in early 6 months of treatment.
Abstract—Hepatitis B virus (HBV) infection is one of the major global public health problems with nearly 2 billion people infected worldwide. So this present study was planned to have information about socio-demographic characteristics of study subjects, level of knowledge about Hepatitis B and vaccination among adults. A cross-sectional, community-based study about hepatitis B knowledge and vaccination status among ethnic 1300 Kashmiri population aged 18 years and above was conducted. The study area was block Hazratbal of district Srinagar. There were 970 (74.6%) females and 330 (25.4%) males. Majority of our participants (54.7%) were in the age group of 21-40 years. Most of the participants were from urban areas(68%), currently married(66.8%), illiterate(64.8), members of joint family(59%) and belonging to socio-economic class II(67.2%). Regarding knowledge, only 10.2% subjects had heard of Hepatitis B before this study. Among them, 50 (37.6%) participants were aware of the modes of transmission of this disease. About the Hepatitis B vaccination, only 26 (2%) participants out of 1300 had ever received the vaccine. Keeping in view, the low level of knowledge about Hepatitis B in the general population, there is a need to organize health education campaigns targeting both health care workers as well as public, so that they adopt all possible measures to prevent the spread of this fatal infection.
Quality of life and its sociodemographic and clinicalpredictorsamong people o...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
Competition genomic medicine presentationResearchsio
Prepared By Roman Sharkar and Mir Tasfiq Alam. Both of them are students of the B.Pharm Program in Bangladesh. They prepared this ppt file from their choice of interest which is Genomic Medicine. Hope this will handly to the others who are interested in this topic !!
Malaria Control Strategies among Rural Dwellers in a Typical Nigerian Settingasclepiuspdfs
Malaria is a major public health problem in sub-Saharan African, including Nigeria, causing 63% of total outpatient attendance in health facilities, 30% under-five mortality, and 11% of maternal mortality. Malaria control practices remain a major strategy in the combat of this menace. Therefore, the aim of this study is to determine the malaria control strategies utilized among rural dwellers in the Ezza North local government area (LGA) of Ebonyi state.
Factors Influencing the Uptake of National Health Insurance Schemes among the...Premier Publishers
Purpose: Penetration of health insurance in the informal sector is very poor, this calls for upward scaling of successful interventions to remedy this situation given that health insurance increases access to healthcare services and improves financial risk protection. This study assessed the factors influencing uptake of national health insurance schemes among informal sector in Vihiga sub-county, Kenya.
Methods: Descriptive cross-sectional study design was used. The target population was the informal sector workers. A sample of 384 participants was selected by cluster and simple random sampling techniques. Data was collected using a semi-structured questionnaire. Descriptive statistics was summarized using tables, chi-square and bivariate logistic regression were used to test for associations (p<0.05).
Results: The study revealed that there was a significant influence of trust and knowledge of the health insurance scheme on the uptake of national health insurance (p < 0.05). The study further revealed that the attractiveness of the scheme had a big influence on the uptake of national health insurance
Conclusion: Trust and knowledge of the health insurance scheme had significant influence on uptake of national health insurance. Health Insurance Schemes should be designed in such a way that they attract informal sector workers and information regarding these schemes is disseminated to these people.
People Living with Human Immunodeficiency Virus in Hadhramout: Clinical Prese...asclepiuspdfs
The objective of the study was to determine the clinical features and outcome of patients living with human immunodeficiency virus (HIV) in Hadhramout and nearby governorates. Materials and Methods: This descriptive study was conducted in the antiretroviral therapy (ART) site at Ibn-Sina General Hospital, Mukalla, Hadhramout governorate. All 145 patients were enrolled in HIV treatment and care program from December 2008 to the end of December 2016 with confirmed HIV test. Data included all personal data, clinical staging, drugs taken, and outcomes. Patients were grouped according to the decades to five groups, ≤15 years, 16–30 years, 31–50 years, 51–70 years, and >70 years. Cases classify according to the antiretroviral drugs to ART group and Pre-ART group. The relevant data parameters were analyzed using SPSS statistical software version 21 and Excel 10. Results: A total of 145 cases, most adults (97.9%), males and females were104 (71.7%) and 41 (28.3%), respectively. Mean age was 36.46 years and 30–50 years the most affected age group (55.2%). Clinical Stages 3 and 4 were the common presentation in 73.8%, and most cases were from Mukalla city. Of the total cases, 74.5% were on ART 53.1 of them improved, pulmonary tuberculosis was found in 4 cases, and death cases were (18.5%), mostly due to late presentation and non-adherence, and mostly occurred in early 6 months of starting the ART. 37 patients were in a pre-treatment group (21.6%), where the mortality rate is 35.1%, mainly due to loss of follow-up. Conclusions: Most cases were adult males, young age and have had late presentation, where mortality is higher in the pre-treatment group due to loss of follow-up and in early 6 months of treatment.
Austin Journal of HIV/AIDS Research is an open access, peer reviewed, scholarly journal dedicated to publish articles in all areas of research in HIV/AIDS. The aim of the journal is to provide a forum for researchers and other health professionals to find most recent advances in the areas of HIV/AIDS research and treatment.
Austin Journal of HIV/AIDS Research covers special areas of virology such as HIV/AIDS diagnosis, early detection, prognosis, epidemiology, transmission, palliative care and large multicentre studies of new therapies.
Austin Journal of HIV/AIDS Research accepts original research articles, review articles, case reports, clinical images and rapid communication on all the aspects of diagnosis and treatments of HIV/AIDS.
Running head: ASSIGNMENT 3 1
ASSIGNMENT 3
4
Assignment 3
Diamond Fulton-Hicks
Saint Leo University-HCA:402
Mrs.Claudette Andrea
04/05/2020
According to the CDC, Youth Risk Behaviors are used in monitoring the six groups of health-associated practices that are contributing to the top causes of deaths and disability amongst youths and adults. Some of these behaviors are those which are contributing to unintended injuries and violent behavior; sexual practices which lead to unintentional pregnancies and sexually transmitted infections; alcohol and other drug use; tobacco use; detrimental dietary practices; and the insufficient engagement in the physical exercise. This paper is therefore based on discussing these health behaviors top factors associated with the increased death and disability rates amongst youths and adults (Centers for Disease Control and Prevention, n.d).
Alcohol and other drug use
Alcohol and other illicit drug are used by the majority of the youths as compared to tobacco use. It is contributing to about 41 percent of all deaths that are caused by motor vehicles. When compared to other behaviors that put human at risk concerning health, alcohol is causing a wider variety of injuries and it is approximated that 100,000 deaths occurs as a result alcohol consumption every year in the U.S. About 46 percent of Americans have been intoxicated in the previous years and roughly 4 percent have been intoxicated weekly (Kann, et al., 2014).
Behaviors causing unplanned injuries and violence such as suicide
The injuries and violent behavior are considered to be amongst the top causes of death amongst the youth of ages 10 to 24 years. The motor vehicle crashes are contributing to 30 percent of deaths and other accidental injuries contribute to 15 percent. Homicide and suicide are contributing to 15 and 12 percent death cases respectively (Centers for Disease Control and Prevention, n.d).
Tobacco Use
It is estimated that there are about 3,600 adolescents of ages 12 to 17 years in the United States who have tried their first cigarette. The use of cigarettes is contributing to 1 to every 5 deaths (Centers for Disease Control and Prevention, n.d).
Unhealthy Dietary Behaviors
Healthy eating is linked to the reduction in the risks of diseases that exposes individuals to death and these diseases include heart disease. In 2009, it was reported that about 23.3 percent of the high school learners reported increased habit of consuming fruits and vegetables five or more times every day. Studies have shown the relationship in the habit of eating the restaurant foods and the increased BMI thus exposing individuals to diseases such as obesity and other cardiovascular diseases (Kann, et al., 2014).
Physical Inactivity
The decline in physical activity is common among children when they get older. Most of the youths are spending their time in a sedentary lifestyle such as watching television with less participation in physical ...
Gender,HIV/AIDs Transmission: Socio Economic And Socio Cultural Impact in Tan...Sandeep Singh
The research was done in Tanzania and presented at Banaras Hindu University International Conference who also published Complete article in "EDUCATION FOR THE NEW MILLENNIUM" by Nutan Publication Chapter 6 ISBN: 978 81 927002 1 2
Socio-Economic Effect of HIV/AIDS on Orphans and Vulnerable Children in Nyami...paperpublications3
Since the first case of HIV/AIDS was reported in Kenya in 1984 the numbers of those infected have risen and many people have since died or are living with the HIV/AIDS since the epidemic started in 1980s in the drug injecting people and the homosexuals. These deaths have resulted in Orphans and Vulnerable Children (OVC). This was a descriptive cross-sectional study, with one of the objective of finding out the socio-economic effect of HIV/AIDS on Orphans and Vulnerable Children in Nyamira district. A sample of 384 people participated in the study. The people were through simple random selected from Bonyegwe sublocation of Nyamusi division. Semi-structured interview schedules were used in data collection from the households. To remove ambiguity, the research tools were pre-tested to both HIV/AIDS organizations and householders not in the sample population but with similar characteristics. The research tools were refined and used on the actual sample population. Text, graphs, figures and tables were used in data presentation. The study indicates that those people who had not attained any level of formal education were (17%). The study revealed that householders (40%) had higher proportion of secondary education as compared with members of HIV/AIDS organizations (37%). Most of the members of HIV/AIDS organizations (89%) indicated that farming is their main source of income and a cushion for food security as compared with householders (63%). The ministry of health should strengthen provision of PMTCT services at the ANC clinic so that we prevent more cases of orphans and vulnerable children. The study suggests that in future all mothers who test positive for HIV virus should be put on treatment in order to reduce defaulters at the same time reach sustainable coverage in the provision of HIV/AIDS services to the orphans and vulnerable children in the society.
Achievements and Implications of HIV Prevention Programme among Female Sex wo...QUESTJOURNAL
Background: Plateau State, Nigeria with HIV prevalence rate of 7.7% as at 2010 had among the highest HIV and syphilis levels in Nigeria, earning itself a reputation of being one of the 12 + 1 states contributing the highest HIV prevalence in Nigeria and described as “hot zone” of HIV infections. Factors responsible for this were not unrelated to the high-risk activities of Female Sex Workers (FSWs). This paper therefore presents achievements and implications HIV prevention among FSWs in Plateau State, Nigeria Methods: This project was an intervention effort focused on delivering evidence-based HIV prevention activities among FSWs in 3 local government areas within the State. The estimated target population for the study was 460 and this project used the minimum prevention package intervention (MPPI). Peer educators were selected and trained among the FSWs to reach out to their peers using cohort session. Data were documented using various monitoring and evaluation tools, entered on the District Health Information Software version 2 and analyzed using Microsoft Excel. Results: A total of 68 community dialogues were held with 1,466 influencers participating in the process. In addition, 601 peers were registered, while 18 persons benefitted from 27 income generation activities aimed at capacity building for FSWs. A total of 642 persons were counseled, tested and shown their results, with 15 persons tested positive resulting in HIV prevalence of 2.3%. Although 10,560 condoms were distributed however, these numbers was below the number of condoms required during the intervention. Conclusion: This intervention was a success. However, more needs to be done with regards to condom distribution and supply among FSWs since there is a crucial role for FSWs to play in the plot of taking the HIV prevalence of Plateau State even further down
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
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Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
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Healthcare seeking and sexual behaviour of clients attending the suntreso sti clinic
1. Journal of Biology, Agriculture and Healthcare www.iiste.org
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Healthcare Seeking and Sexual Behaviour of Clients Attending the
Suntreso STI Clinic
Ramatu Agambire, RGN, BSc, MPH1*
; Dr. Christine Clerk, MD, MPH, PhD2
;
1. School of Nursing, Garden City University College, Kumasi-Ghana
2. School of Public Health, University of Ghana Legon
*ragambire@yahoo.com/ramatu.agambire@gcuc.edu.gh
Abstract
Every year 340 million people are infected by four most important sexually transmitted infections excluding HIV
namely syphilis, gonorrhoea, trichomoniasis and chlamydia. Sixty-nine million of these infections occur in sub-
Saharan Africa. What people do when they have a symptom or a suspicion of STIs has major implications for
transmissions and consequently for disease control. This study examined the reasons for patterns of health
seeking and related sexual behaviours of patients who presented at the STI clinic in Suntreso, Kumasi. This was
a cross sectional descriptive study. A study of clients with Sexually Transmitted Infections (STI) attending an
STI clinic in Kumasi, Ghana found that of 185 patients, Sixty four percent (n=119) of them delayed for more
than 4 weeks before seeking treatment at the clinic and another 61% (n=114) had sought treatment elsewhere and
Eighty percent (n= 148) of the patients had sex whiles symptomatic.
Keywords: Disease, infected, health seeking.
1. INTRODUCTION
Sexually Transmitted Infections have become a major health problem globally, and their prevention has been a
priority since HIV/AIDS emerged as a life-threatening disease (Wasserheit, 2001; World Bank, 2006).
Every year approximately 340 million people are infected by four most important STIs excluding HIV (WHO,
2006). These infections are syphilis, gonorrhoea, trichomoniasis and Chlamydia (Fonck et al., 2001). An
estimated 69 million of these infections occur in sub- Saharan Africa. In the recent Demographic and Health
Survey in Ghana, 3% of women and men who have ever had sex reported having had STI 12 months before the
survey (GSS, 2009).
STIs and HIV/AIDS are spread through certain high-risk behaviours and both diseases share the same
epidemiological risk factors. Because they are spread through similar behaviour, people exposed to other STIs
are an easily identifiable group at high risk of HIV infection. The control of STIs is therefore an important step
in slowing the spread of HIV infection. Successful interventions have shown that early detection and treatment
of STIs decrease the incidence of HIV/AIDS. Grosskurth et al., in 2005 showed that improved STI treatment
reduced HIV incidence by about 40% in a rural population (Mwanza) in Tanzania. The most convincing
epidemiological evidence was a study that examined seroconversions rates among people with ‘’comparable ‘’
sexual exposure and different incidence rates of STI. This study demonstrated that the risk of acquisition of HIV
in the presence of ulcerative or non ulcerative STI is increased by a factor of two to six (Mensch et al., 2008).
One parameter determining the transmission dynamics of STI in a given population is the duration of time that
an individual with STI is sexually active. Thus, inspite of the effectiveness of treatment regimens, the impact of
an STI control programme also depends on when infected individuals seek treatment and the extent to which
they have unprotected sexual activity during this period (McIlhaney, 2000).
Due to stigma surrounding sexuality, STIs remains a hidden epidemic (Wilkinson, 2002). The consequence has
been sustained STI epidemics with increased spread of HIV, leading to huge personal and economic loss. The
longer a person has an STI, the greater the chance of complications and the risk of infecting others. Factors that
prolong the period of infectiousness are thus of great clinical and public health importance and early healthcare
seeking is critical in the early detection and control of STIs (Ward et al., 2007).
Studies on health care-seeking behaviour concerning STIs showed that delay in seeking care is common among
STI patients (Aral et al., 2009; Fonck et al., 2001). The prevalence of delay in seeking treatment for STIs in both
industrialized and developing countries ranges from 23% to 73% (Pitts et al., 2000). The use of health facilities
in developing countries is referred to as being complex compared to developed countries on account of the
choices between different health care systems (Kroeger, 2003). In the developed countries patients tend to use
health facilities more frequently thus about 85% will seek treatment for any illness as compared to developing
countries where only 25% will seek treatment or even visit a health facility. A study in the Netherlands and
China among clients with STI showed that 27% of the sample delayed seeking care by more than 4 weeks as
compared to study in Kenya by Fonck et al., 2001 where 63% delayed in seeking care. Therefore it has been
suggested that early health care-seeking behaviour be promoted as a part of STI health care (Aral et al., 2009). A
better understanding of the factors influencing treatment seeking behaviour is critical for effective STI control.
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Understanding these factors could assist in developing health education initiatives and public health programmes
to control STIs and in turn, HIV.
This study aims to assess healthcare seeking behaviour and factors associated with care- seeking among patients
attending a specialized STI clinic in Kumasi. The information will contribute towards the development of
appropriate health education programmes to help reduce the spread of STIs and HIV/AIDS in high-risk
populations.
The study however did not consider HIV patients unless they reported with other STIs.
Problem Statement
Suchman (2009) estimated that STIs constitute one of the ten main health problems responsible for loss of
healthy life years.
A significant number of Ghanaians suffer from STI and many have multiple sexual partners but do not use
condoms to protect themselves (Adu-Sarkodie et al., 2000). A study on the prevalence of STI among
commercial sex workers in Accra and Kumasi showed prevalences of 75 percent and 80 percent respectively
(Agyarko-Poku, 2001).
Furthermore what people do when they have a symptom or a suspicion of STIs has major implications for
transmissions and consequently for disease control. Delays in seeking and obtaining diagnosis and treatment can
allow for continued transmission and a greater probability of developing of adverse sequelae (WHO, 2006)
A review of patients’ records at the Suntreso STI clinic from January to December 2000 showed that more than
50% had had symptoms for a week or more before reporting to a regular clinic and had spent another week
before coming to the referral centre (Agyarko-Poku, 2001).
As most STIs are asymptomatic, infected people may continue to have sex thereby increasing the transmission
cycle.
An understanding of the health seeking and sexual behaviour of STI patients is therefore important if STI control
programmes are to be effective.
2. Literature Review
2.1 Health Care Seeking for STI
‘Illness’ means an unhealthy condition of body or mind. The term ‘Patient’ denotes an individual under medical
treatment (Ward et al., 2007). Although an illness leads to a person seeking care, not all those with illness
become patients. Symptoms are subjective evidence of illness, and according to Wilkinson et al., 2002 the way
these symptoms are perceived, evaluated and acted (or not acted) on is defined as ‘Illness behaviour’. Illness
behaviour does not always lead to seeking health care. A person has to take action in order to get relief from a
symptom or illness. Any attempt at finding a remedy for a perceived illness is defined as “health care-seeking
behaviour” (Ward et al., 2007).
One of the interventions outlined in the WHO Global Strategy for STI is the “Promotion of early recourse to
health services by people suffering from STIs and by their partners’. This aims at promoting early healthcare
seeking among clients.
Effective and accessible STI treatment and prevention programmes are key to reducing the global burden
associated with STI.
The use of health facilities in developing countries is referred to as being complex compared to developed
countries on account of the choices between different health care systems (Kroeger, 2003).
In many developing countries the patient’s first encounter for STI is self medication and treatment in the
informal health sector. Over- the- counter purchases of antibiotics at pharmacies (drug store or chemist shop) or
from a drug vendor and quack doctors is almost universal despite laws that regulate the distribution (Darj, 2003).
The treatment obtained from these sources is frequently inadequate or ineffective. Patients do not often receive
the benefit of prevention education including condom use and their sexual partners are not treated or counselled.
In Ethiopia getting care from a government health clinic was often the last resort for therapy. Reasons cited by
community members included the stigma of STI- only clinic, long waiting time, judgemental staff , consultation
fee, social implication of being seen as an STI patient and lack of privacy (Laga et al., 1999).
Studies in Uganda and Kenya about healthcare seeking indicate that STIs are commonly held to be better treated
by traditional healers (Darj, 2003; Fonck 2001). Such findings relate to the decisions about where to seek care.
A similar study carried out in Malawi showed that 53% of clients had sought treatment elsewhere with the
frequent alternative source being the traditional healer (Mensch, 2008).
2. 2 Potential Factors Influencing STI Health Care-Seeking Behaviour
There are three large categories of social and behavioural factors that influence clients to seek timely treatment
for STIs (Aral et al., 2009). These are patient characteristics (behaviour) Provider characteristics (attitudes of
health care providers) and the healthcare system (organization of the health care delivery system) (Aral et al.,
2009). These factors influence the timely and appropriate care seeking of STI patients at various levels.
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Knowledge of the factors that influence people’s decision to seek treatment for STIs will provide a better
understanding of where people go for treatment for an STI, and who goes where. For instance, where people
choose to go for treatment could be influenced by provider characteristics like their previous experience with
health care providers, as well as their perceived efficacy of the treatment provided by specific providers. Other
factors that could influence where people go for treatment include patient characteristics, such as education,
income, health insurance coverage, age, sex, race or ethnicity, religion and marital status. Characteristics of
healthcare system could also influence patient choice, such as their geographic distribution, availability of
support services, quality of care, convenience and privacy.
In a Kenyan study, 41% of 471 clients attending an STI clients waited for 4 weeks, and 23% delayed for more
than 2 weeks before seeking care stating reasons like attitude of staff, lack of privacy and clients’ age as a major
determinant of ability to seek care (Fonck et al 2001). Another study in Singapore showed that 73% waited for 4
week and 27% delayed for over 2 weeks before seeking care. Reasons for delay include: social stigmatization
against sexual promiscuity, fear of public exposure, embarrassment, and lack of privacy (Leenars et al., 2003).
Delay in health care-seeking behaviour seems to be significantly associated with extreme age groups (Zachariah
et al., 2002). Younger age groups often lack knowledge on STIs; this might cause them to underestimate the
risks. In a study conducted among adolescents in the US and South Africa, ignorance of the seriousness of STIs
was found to be associated to delay in seeking care. The subjects (54%) thought symptoms would subside and
tended to wait longer than 10 days for a resolution. Also, fears of notifying parents served as a barrier to seeking
care among 45% of the adolescents.
Among older study participants, those aged 45years and above 68% tended to delay seeking care and the reasons
for delaying were: waiting for resolution (34%) and embarrassment or fear of attending the STI clinic (24%). In
another study in Uganda among STI clients, 74% of clients aged 50 years and over delayed more than 4 weeks
before seeking care (Bearinger et al., 2007). The reasons cited were embarrassment (30%) and the social
implication of been seen as STI clients (32%).
2.3 Sexual Behaviour
There is renewed interest in human sexual behaviour and the factors influencing it as a better understanding will
help to lessen the formidable threat of the new and uniquely dangerous epidemic of STIs (Agnius et al., 2008).
Worldwide condom is used by 5 per cent of couples and it accounts for 8 per cent of overall contraceptive use.
The prevalence of condom use is higher in the more developed regions than in the less developed regions (13 %
vs. 3 %). Condom prevalence is lowest in Africa (1 %) but in Ghana the prevalence of condom use increased
from 0.3 per cent in 1999 to 2.7 in 2005 (UNAIDS, 2009). In Australia although consistent condoms use
remains moderately high, it is of some concern that condom use has not increased since 1997 despite related
increases in sexual activity among the people who have experienced sexual intercourse and increased rates of
STIs (Agnius et al., 2008).
A study carried out among clients attending an STI clinic in Malawi showed that 76% of clients had sex during
the symptomatic period of STI (median 14 days) with the majority (74%) not using condoms (Zachariah et al.,
2002).
Important skills are also required to engage in prevention behaviours which include the ability to effectively
communicate with one's sex partner about safer sex, refusal to engage in unsafe sexual practices, proper use of
barrier-method contraceptives, and the ability to exit a situation when prevention behaviours are not possible
(Dubois, 2006, Hammerschlag, 2004).
A study conducted among college girls in the US found that the person who suggested the use of a condom was
seen as somebody who was not romantic, yet more mature, than those persons who did not suggest the use of a
condom. If the woman suggested a condom, the perception of her was that she was not as promiscuous as the
women who did not suggest the use of a condom (Fortenberry et al., 2002).
In developing countries however the situation is different where women are often unable to negotiate for sex due
to socio-cultural reasons and the fear of been seen as promiscuous.
Sexual behaviours also contribute to the STI burden in developing countries. These behaviours are heavily
influenced by the socio-cultural, economic, and political contexts, which in the past two decades have
deteriorated at an accelerated rate in many areas. Societal change has included rising levels of inequality within
countries, growing inequality between countries, increased levels of globalization, increased proportions of
people who live in cultures they were not born in and a larger proportion of the world’s population living in post
conflict societies (Aral et al., 2009). One effect of these changes is an increase in multipartner sexual activity,
which in turn increases the rate at which infected and susceptible individuals are sexually exposed to each other
and consequently the rate at which STIs spread.
2.4 Knowledge and Prevention of STI
The rising number of HIV infections and other STIs among patient population has called for behavioural
interventions with the aim of empowering clients with increased knowledge as well as an increased perception of
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risk of STIs.
Two of the most universally acknowledged issues are STI-related knowledge and stigma.
Possessing information about STI is essential to be able to recognize and correctly interpret one's signs and
symptoms as manifestations of an STI for prompt care-seeking, a lack of knowledge does not always explain
delays in care-seeking behaviour (Meyer-Weitz et al., 2000, Liu et al., 2003). For example, in a study of
adolescents attending a public STI clinic in Chicago, greater levels of knowledge were associated with delayed
care-seeking among females (Fortenberry, 2002). It is possible that fear of stigma or the emotional consequences
of having an STI may supersede a person's concerns for their well-being when he/she suspects that they may be
infected (Annang et al., 2007).
In addition to understanding what impedes or facilitates persons with or at-risk for STIs to access clinical care, it
is also of public health importance to provide quality health education and counselling to those who do access
care in order to prevent new infections (Fortenberry, 2002, Scoular, 2001, Amaro et al., 2001). However,
research has shown that the opportunity for post-diagnosis STI-related prevention interventions is often missed.
In a study in Brazil, post-test STI counselling does not appear to be universally offered or of consistently high
quality based on research conducted. A study conducted by Giffin and Lowndes (1999) found that of 42
Brazilian women who were interviewed immediately after having received a positive result for Chlamydia in the
context of routine gynaecological care, only two understood that the disease was sexually transmitted and only
four knew the correct name of the disease. Approximately half of the gynaecologists interviewed in this study
reported that they did not explicitly inform the patient that her condition was sexually transmitted. The primary
reasons for not discussing the specifics of the STI diagnosis cited by providers were the desire to avoid causing
potential relationship problems for the couple, particularly in the case that the patient was married, and feeling
that dialogue regarding sex and sexuality were beyond the scope of their professional responsibilities (Giffin et
al., 1999).
Another study carried out to better understand both the factors that influence STI care-seeking and the quality of
health education and counselling received among heterosexual women, heterosexual men, and men who have
sex with men (MSM) attending two large, public STI clinics in Nwanza, Uganda. The results indicated that upon
presenting at a clinic not all individuals received adequate education and prevention counselling from health care
personnel. Only a minority (23%) of participants reported having discussions regarding condom use or partner
notification with their attending STI care provider calling into question the quality of health education efforts at
these public clinics (Grosskurth et al., 2005).
3. DISCUSSION
An important determinant of transmission dynamics of STIs in a given population is the duration of time a
person with an STI remains infectious and is sexually active. Hence apart from the effectiveness of the treatment
regimen, the success of STI interventions to reduce transmission is also influenced by the time that infected
individuals wait before initiating treatment and the extent of their unprotected sexual activity during that period.
Understanding the factors influencing delay in health care-seeking behaviour among patients with STI is
essential in the development of appropriate health education programmes for health workers involved in STI
control.
This study examined a cross section of patients attending an STI clinic in Kumasi. These individuals constitute a
high-risk group for transmitting STIs, including HIV and are a priority target group for interventions.
One limitation of this study is the fact that only those who experienced STI symptoms and sought care at the
designated clinic were included in this study. Those who did not seek care may have different characteristics and
this may limit the generalization of the study findings.
Also both sexual activity and condom use while symptomatic were self-reported. This may lead to recall bias
and socially desirable answers. However, the study was conducted among new clients attending the clinic and it
is possible that recall bias was minimal.
3.1 Healthcare Seeking Behaviour
From this study, 64.3% of the patients delayed for more than 4 weeks before seeking treatment for a possible STI
(n=119), reasons cited for not reporting immediately symptoms started were embarrassment (38.7%), hope that
symptoms will go away (16%), not knowing where to go (31.1%) and 5% thought symptoms were not important.
The results of this study reassert previous studies’ findings (Aral et al., 2009, Fonck et al., 2001) that delay
between symptom recognition and health care seeking is a feature of STI-related illness behaviour. These were
studies in Kenya and Uganda among STI clients, in which 63% and 56% respectively delayed for more than 4
weeks before seeking care. Reasons cited were lack of knowledge about the importance of seeking prompt
medical care (36%), lack of information about available services (34%) and finally lack of financial resources
(21%)
The results of this study point to salient determinants of the delay in health care-seeking behaviour of patients
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with STIs that need to be addressed in health education programmes with a view to facilitate early diagnosis and
treatment.
Delay in health care-seeking behaviour was significantly associated with whether client had heard of STI and
specific STI symptoms. A significantly higher proportion of patients who had not heard of STI sought treatment
late compared to those who had heard of STI
(p<0.001). Clients seeking care who had genital discharge sought care late as compared to clients who had sores
over genitalia or dysuria (p < 0.001).
A study in Uganda among STI clients showed that the severity and nature of the symptoms may influence a
person’s decision to delay in health care-seeking behaviour. Having sores around the genital area was
significantly associated with seeking care earlier and vaginal discharge was associated with a delay in seeking
care (p value<0.001) (Nuwaha, 2009).
This reflects the influence of severity of the symptoms over health care-seeking behaviour. Thus patients’
perception of genital ulcers as being more serious compelled them to seek care earlier as compared to vaginal
discharge which was possibly not deemed serious. Similar observations were made in a study among female STI
clients in the US in which persons with genital warts sought care early compared to those with genital discharge
(Hook et al., 2007). Thus if the symptom does not intervene with a person’s activity then these people may
postpone seeking care.
Among the clients attending the clinic, 61.6% had sought care elsewhere citing the social implication (immoral
behaviour) of being an STI client 32.5%, long waiting hours (21.9%), lack of privacy (21.1%) and stigma of STI
only clinics (16.7%) as some of the reasons for seeking care elsewhere. A study in Ethiopia among 315 STI
clients also showed that getting care from a government health clinic was often the last resort for therapy. Some
of the reasons documented for the delay were the stigma of STI- only clinic (20%), long waiting time (15%),
judgemental staff (10%), consultation fee(10%), social implication of being seen as an STI patient(25%) and
lack of privacy(20%) (Laga et al., 1999). A similar study in Kenya among 471 clients with STI found that choice
of an STI clinic was often the last option due to reasons like convenience of the location (25%), privacy (18%),
affordability (18%) of the services and social implication of being seen as an STI patient (25%) (Fonck et al.,
2001). Similar observations were made by Nuwaha (2009) in Uganda where 45% of patients reported late
because they believed the symptoms were not serious.
In many developing countries the patient’s first encounter for STI is self medication and treatment in the
informal health sector. Over- the- counter purchases of antibiotics from pharmacy shops or from drug vendors
and quack doctors is almost universal despite laws that regulate the distribution (Darj, 2003).
Self-medication (35.1% in this study) has been shown as a factor influencing delay behaviour from previous
research. In this study 28 out of the 40 respondents who self medicated reported to the STI clinic late. Although
this has reaffirmed what other studies have found in Kenya and Uganda (Darj, 2003; Fonck, 2001), quite a
different situation was reported in Singapore where a similar study found a much lower proportion (9%-11.1%).
This was attributed to the strict rules on the availability of antibiotics over the counter (Gordon et al., 2003; Irwin
et al., 2007). Considering increasing cases of drug resistance to common STIs around the world, health education
on the consequences of self-treatment has to be emphasized in health education programmes.
Age significantly influenced health care-seeking behaviour (p<0.05). Those aged 26–35years tended to delay
seeking care compared with other age groups. There was no significant association between delay in health care-
seeking behaviour and educational level or marital status. No association was also found between delay in
healthcare seeking and occupation of respondents as well as gender. A study in Kenya also found that age was
the only determinant of healthcare seeking with the other socio demographic characteristics playing no role in
determining how long they waited. Clients aged 26-30 years delayed before seeking care as compared to the
other age groups (Fonck et al., 2001).
A study conducted among adolescents attending an STI clinic found that clients aged 18-23 in the US reported
that ignorance of the seriousness of STIs was associated with delay in seeking care (MacDonald et al., 2003).
There was no significant association between delay in health care-seeking behaviour and educational level or
marital status. No association was also found between delay in healthcare seeking and occupation of
respondents. Gender had no significant influence on health care-seeking behaviour (p-value=0.09). There were
however more women (70%) than men in the study. A similar study in Kenya among clients with STI found that
although women delay in seeking care than men, they tend to report more often than men citing reason like
women being more susceptible to STI and increased risk of complications in women.
In another study in Uganda, men more often than women report a different healthcare-seeking attitude when
confronted with an STI. The men in this study reported attending the public health sector significantly more
often for a STI than for other health problems. This implies that more of the men will have sought care elsewhere
before reporting to the clinic thus if the symptoms persist afterwards. STI case management must be offered as
widely and effectively as possible to have a significant impact on the STI epidemic.
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3.2 Sexual Behaviour Eighty percent of the patients continued to have sex whiles they were experiencing
symptoms suggestive of STIs. It has been suggested that reluctance of the patient to admit having an STI
symptom (denial) or thinking that the symptoms were not a priority, may be the reason for continuing sexual
activity with symptoms (Nuwaha, 2009). It is also suggested that the severity and nature of the symptoms may
influence the delay in health care-seeking behaviour (Dubois, 2006, Wilkinson, 2002). This study found that
severity of symptoms had significant influence over health care-seeking behaviour. Those who had severe and
unpleasant symptoms like genital sores had sought care early compared to those with symptoms such as vagina
discharge.
Sexual behaviours also contribute to the STI burden in many countries. These behaviours are heavily influenced
by the socio-cultural, economic, and political contexts, which in the past two decades have deteriorated at an
accelerated rate in many areas (Aral et al., 2009).
In this study twenty one percent of the respondents reported having had two or more sexual partners this asserts
to the issues raised by Aral in 2009 that changes in socio-cultural, economic and political context leads to an
increase in multi-partner sexual activity, which in turn increases the rate at which infected and susceptible
individuals are sexually exposed to each other and consequently the rate at which STIs spread.
About 80% of the respondents continued having sex while having STI symptoms. Among those who had sex
while having symptoms of STI, a majority (89%) did not use condoms and this is in agreement with the national
estimates of decreasing trends of condom use. It is estimated that just about 2.7 of the population use condom as
a form of protection against STI/HIV. A study carried out among clients attending an STI clinic in Malawi
showed that 76% of clients had sex during the symptomatic period of STI with the majority (74%) not using
condoms (Zachariah et al., 2002). In Ghana, a similar study also found that a significant number of Ghanaians
suffer from STI (47%) and many have multiple sexual partners (54%) but do not use condoms (58%) to protect
themselves (Adu-Sarkodie et al., 2000).
STIs and HIV/AIDS are spread through certain high-risk behaviours and low condom use is one of such
behaviour. Because they are spread through similar behaviour, people exposed to STIs are an easily identifiable
group at high risk of HIV infection. Thus the number of people exposed to STI in this study could all have
contracted HIV through this risky behaviour. Grosskurth et al., in 2005 showed that improved STI treatment
reduced HIV incidence by about 40% in a rural population (Mwanza) in Tanzania. Promoting condom use is
therefore essential in reducing the spread of this silent epidemic alongside HIV.
The sexual partners of the clients seeking care at the clinic were mostly their girlfriends or boyfriends (57.5%).
Three percent of the clients had sex for cash and 39.8% with their spouse. There was no significant association
between perceived source of an STI with delay in health care-seeking behaviour. The presumed sources of
infections for these clients were: spouse (10.8%), casual partners (24.9%) and girlfriends/boyfriends (13.5%).
About half (50.8%) of the patients did not know the source of the suspected STI. This is an issue worth looking
into because if these respondents cannot tell the source of infection then partner treatment becomes difficult and
this only means that they can easily go back to get infected increasing risk of complications and treatment
failure.
Partner notification is important for interrupting the transmission of STIs and preventing possible eventual
reinfection, but in practice there are obstacles. Patients may not inform their sex partners out of fear,
embarrassment, or unawareness of the importance of doing so. In resource-poor settings, it is usually impractical
for notification to be done by the health sector (WHO, 2006). Clients’ level of education did not affect their
decision about having sex whiles symptomatic (p value >0.05). Also clients’ level of education did not influence
their decision to either use condom or not use one. This goes on to show that important skills are required to
engage in prevention behaviours which includes the ability to effectively communicate with one's sex partner
about safer sex, refusal to engage in unsafe sexual practices and proper use of condoms and these skills have
nothing to do with ones level of education (Dubois, 2006, Hammerschlag 2004).
3.3 Knowledge on STI
Ignorance or misinformations are powerful obstacles to resolving problems, and this is particularly true where
STIs and HIV/AIDS issues are concerned. Ignorance of STIs and AIDS can exist in all types of people and all
age groups. However it is more widespread among adolescents and young people, the very people who are likely
to be more sexually active than others, unlikely to be in stable sexual relationships, and who have poor access to
STD care services (Dubois, 2006). In this study (79.9%) of the participants were below 35years of age. The level
of knowledge of clients on STI was good as 77.8 percent of the patients had ever heard of STI. Among the
respondents, 20.5% reported that they had heard about HIV or AIDS. The majority (77.8%) had heard about
STIs and knew the common STI names such as: gonorrhoea, syphilis, herpes and chlamydia. Gonorrhoea
(35.1%) and syphilis (17.8%) were the most common names reported by the respondents, with 20.5% unable to
mention any STI which was a bit disappointing especially since clients were interviewed when they were exiting
the STI clinic. Respondents were asked about ways in which STI can be transmitted and effective methods of
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protecting themselves from STIs. A few misconceptions were cited as the cause of STIs: sharing toilets (4.9%),
by sharing under pants 8.6%. The majority however correctly reported by having unprotected sex (64.9%). Level
of education was significantly associated with knowledge of the methods of prevention of STIs (p<0.001) as
well as ability to name any STI (p=0.01). On the other hand, level of education was not significantly association
with respondents’ knowledge on how STIs can be contracted (p value >0.13 This reiterates the fact that level
education does not necessarily mean people are informed about issues and so it is necessary to educate such
people about STI and the importance of seeking early treatment. A study conducted by Giffin and Lowndes
(1999) found that of 42 Brazilian women who were interviewed immediately after having received a positive
result for Chlamydia in the context of routine gynaecological care, only two understood that the disease was
sexually transmitted and only four knew the correct name of the disease.
4. Conclusion
A significant proportion of STI patients (64.3%) delayed in seeking care at the STI Clinic for over 4weeks. This
was due to reasons such as embarrassment (31%), symptoms will go away 38% and 16% did not know where to
go. Eighty percent were sexually active whiles symptomatic and 89% of them did not use any condoms during
this period. Fourteen percent also had more than one sexual partner. STI knowledge was good as 77.8% had
ever heard of STI. Among the respondents, 20.5% reported that they had heard about HIV or AIDS. The
majority who had heard about STIs knew the names of common STIs such as gonorrhoea, syphilis, herpes and
chlamydia. A few misconceptions were cited as the cause of STIs. Some of these were sharing toilets and under
pants. The majority however correctly reported by having unprotected sex. Twenty four percent had no
knowledge about prevention of STIs. The importance of seeking care early for STI and abstaining from sex
during and before treatment, consistent condom use and improving symptom recognition have to be incorporated
in the existing prevention intervention programmes. Those who seek care for STI should be considered as a
primary target for renewed prevention efforts. Since they are already in the STI clinic, personalized counselling
emphasizing the importance of safe sex and early health care-seeking behaviour should be given.
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ACKNOWLEDGEMENT
I am very grateful to God almighty.
My thanks also go to Dr Clerk for the directions and inputs towards this work to make it a success.
I also express my gratitude to the Kumasi Metro Health Directorate,
I sincerely appreciate my family, for financing this project to the very end and for their support and prayers
throughout the MPH programme.
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Technology and Education (IISTE). The IISTE is a pioneer in the Open Access
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