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Rural-urban health-seeking behaviours for non-communicable diseases in Sierra Leone.

ABSTRACT: Introduction:Non-communicable diseases (NCDs) are the leading cause of mortality globally. In Africa, they are expected to increase by 25% by 2030. However, very little is known about community perceptions of risk factors and factors influencing health-seeking behaviour, especially in fragile settings. Understanding these is critical to effectively address this epidemic, especially in low-resource settings. Methods:We use participatory group model building techniques to probe knowledge and perceptions of NCD conditions and their causes, health-seeking patterns for NCDs and factors affecting these health-seeking patterns. Our participants were 116 local leaders and community members in three sites in Western Area (urban) and Bombali District (rural), Sierra Leone. Data were analysed using a prior framework for NCD care seeking developed in Ghana. Results:Our findings suggest adequate basic knowledge of causes and symptoms of the common NCDs, in rural and urban areas, although there is a tendency to highlight and react to severe symptoms. Urban and rural communities have access to a complex network of formal and informal, traditional and biomedical, spiritual and secular health providers. We highlight multiple narratives of causal factors which community members can hold, and how these and social networks influence their care seeking. Care seeking is influenced by a number of factors, including supply-side factors (proximity and cost), previous experiences of care, disease-specific factors, such as acute presentation, and personal and community beliefs about the appropriateness of different strategies. Conclusion:This article adds to the limited literature on community understanding of NCDs and its associated health-seeking behaviour in fragile settings. It is important to further elucidate these factors, which power hybrid journeys including non-care seeking, failure to prevent and self-manage effectively, and considerable expenditure for households, in order to improve prevention and management of NCDs in fragile settings such as Sierra Leone.

SUBMITTER: Idriss A

PROVIDER: S-EPMC7053783 | biostudies-literature | 2020

REPOSITORIES: biostudies-literature

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Rural-urban health-seeking behaviours for non-communicable diseases in Sierra Leone.

Idriss Ayesha A Diaconu Karin K Zou Guanyang G Senesi Reynold Gb RG Wurie Haja H Witter Sophie S

BMJ global health 20200302 2

<h4>Introduction</h4>Non-communicable diseases (NCDs) are the leading cause of mortality globally. In Africa, they are expected to increase by 25% by 2030. However, very little is known about community perceptions of risk factors and factors influencing health-seeking behaviour, especially in fragile settings. Understanding these is critical to effectively address this epidemic, especially in low-resource settings.<h4>Methods</h4>We use participatory group model building techniques to probe know ...[more]

PMID: 32181002

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Project description:BackgroundThough non-communicable diseases contribute to an increasing share of the disease burden in South Asia, health systems in most rural communities are ill-equipped to deal with chronic illness. This analysis seeks to describe care-seeking behavior among women of reproductive age who died from fatal non-communicable diseases as recorded in northwest rural Bangladesh between 2001 and 2007.MethodsThis analysis utilized data from a large population-based cohort trial in northwest rural Bangladesh. To conduct verbal autopsies of women who died while under study surveillance, physicians interviewed family members to elicit the biomedical symptoms that the women experienced as well as a narrative of the events leading to deaths. We performed qualitative textual analysis of verbal autopsy narratives for 250 women of reproductive age who died from non-communicable diseases between 2001 and 2007.ResultsThe majority of women (94%) sought at least one provider for their illnesses. Approximately 71% of women first visited non-certified providers such as village doctors and traditional healers, while 23% first sought care from medically certified providers. After the first point of care, women appeared to switch to medically certified practitioners when treatment from non-certified providers failed to resolve their illness.ConclusionsThis study suggests that treatment seeking patterns for non-communicable diseases are affected by many of the sociocultural factors that influence care seeking for pregnancy-related illnesses. Families in northwest rural Bangladesh typically delayed seeking treatment from medically certified providers for NCDs due to the cost of services, distance to facilities, established relationships with non-certified providers, and lack of recognition of the severity of illnesses. Most women did not realize initially that they were suffering from a chronic illness. Since women typically reached medically certified providers in advanced stages of disease, they were usually told that treatment was not possible or were referred to higher-level facilities that they could not afford to visit. Women suffering from non-communicable disease in these rural communities need feasible and practical treatment options. Further research and investment in adequate, appropriate care seeking and referral is needed for women of reproductive age suffering from fatal non-communicable diseases in resource-poor settings.

Project description:BackgroundUndernutrition accounts for at least 50% of the annual global under-five mortality burden. Although disparities in the childhood stunting between urban and rural areas in Sierra Leone have been documented, information on factors associated with these differences is lacking. We aimed to determine rural-urban correlates of stunting among children under the age of 5 in Sierra Leone.MethodsWe analyzed data from 2019 Sierra Leone demographic and health survey (SLDHS) focusing on under-five children. We conducted multivariable logistic regression to examine rural-urban factors associated with childhood stunting.ResultsPrevalence of stunting was 31.6% (95% CI 29.8-33.2) in rural areas and 24.0% (95% CI 21.6-26.1) in urban areas. Within the rural areas, children of stunted mothers (aOR = 2.37; 95% CI 1.07-5.24, P < .05), younger mothers aged 15 to 19 years (aOR = 2.08; 95% CI 1.17-3.69, P < .05), uneducated mothers (aOR = 1.87; 95% CI 1.28-2.71, P < .01), as well as older children (24-59 months) (aOR = 1.83; 95% CI 1.48-2.27, P < .001), and boys (aOR = 1.37; 95% CI 1.12-1.66, P < .01) were more likely to be stunted compared to those of non-stunted, older, post-primary education mothers and those who were less than 24 months and girls respectively. While urban children whose fathers had lower education (aOR = 1.94; 95% CI 1.10-3.42, P < .05), whose mothers were more parous (para 2-4) (aOR = 1.74; 95% CI 1.03-2.95, P < .05), and boys (aOR = 1.48; 95% CI 1.06-2.08, P < .05) were more likely to be stunted compared to their counterparts with fathers that had tertiary education, mothers of low parity and girls, respectively.ConclusionsStunting is more prevalent in the rural areas compared to the urban areas. Sex of the child was the only significant factor in both rural and urban areas. Our study findings suggest that programs designed to reduce stunting should aim for integrated yet context specific interventions in rural and urban areas.

Dataset Information

Rural-urban health-seeking behaviours for non-communicable diseases in Sierra Leone.

Publications

Rural-urban health-seeking behaviours for non-communicable diseases in Sierra Leone.

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