Experiences of Mothers on the Utilization of Elimination of Mother to Child Transmission of HIV Services at Mtendere Clinic, Lusaka

Introduction: Acquired immunodeficiency syndrome is one of the leading causes of mortality among women of reproductive age and Mother to Child Transmission of Human immunodeficiency virus is still a challenge affecting many countries. Globally, an estimation of 180,000 children under 15 years acquire the Human immunodeficiency virus every day, and more than 90% of those infections are due to Mother to Child Transmission. The study sought to explore the experiences of mothers on the Elimination of Mother to Child Transmission-HIV services at Mtendere Clinic, Lusaka. Materials and Methods: Qualitative interpretive phenomenology study design was employed using in-depth interviews to collect data from a sample that was selected using purposive sampling technique. Thirteen participants were recruited, and these were HIV-positive mothers at least between the ages of 15 and 49 years and enrolled in the Elimination of Mother To Child Transmission-HIV program. The in-depth interviews were audiotape recorded and transcribed verbatim. Data was analyzed using thematic method. Findings: Three main themes that emerged are;living with HIV, support system and barriers to utilization of Elimination of Mother To Child Transmission-HIV services. Most of the participants expressed having acquired knowledge from the program, and received counselling and support from spouses, family as well as health personnel at Mtendere health facility which culminated into a positive experience and enhanced their uptake of the Elimination of Mother to Child Transmission-HIV services. However, barriers to service utilization were identified and these included fear of stigma, negative attitudes from health workers, long waiting times, lack of support and lack of transport to the health facility. Conclusion: Interventions such as community awareness campaigns on Elimination of Mother To Child Transmission-HIV, male involvement and implementing mother-to-mother peer support strategies in Elimination of Mother To Child Transmission-HIV service utilization should be prioritized so as to alleviate stigma and enhancing a positive experience for these mothers thus reducing on the Mother to Child HIV Transmission burden and mortality rates.

A family nurse-led intervention for reducing health services’utilization in individuals with chronic diseases:The ADVICE pilot study

Objectives:Intensive health services'utilization is common in older individuals affected by chronic diseases.This study assessed whether a structured family nurse-led educational intervention would be effective in reducing health services'use(readmissions and/or emergency service access)among older people affected by chronic conditions.Methods:This is a non-randomized before-after pilot study.A sample of 78 patients was recruited from two general practices in Italy and 70 among them were followed for 8 months.Standard home care was provided during the first four months'period(months 1-4),followed by the educational intervention until the end of the study(months 5-8).The intervention,based on the teach-back method,consisted of by-weekly 60-min home sessions targeting aspects of the disease and its treatment,potential complications,medication adherence,and health behaviours.Rates of health services'use were collected immediately before(T0),and after the interventions(T1).Differences in utilization rates were examined by the McNemar's test.Potential factors associated with the risk of health services'use were explored with a Cox proportional hazard regression model.Results:The sample(n=78)was predominantly female(n=50,64.1%),and had a mean age of 76.2(SD=4.8)years.Diabetes mellitus was the most frequent disease(n=27,34.6%).McNemar's test indicated a significant reduction in health services'use at T1(McNemar χ^(2)==28.03,P<0.001).Cox regressions indicated that time and patient education,as well as their interaction,were the only variables positively associated with the probability of health services'use.Conclusion:A teach-back intervention led by a family nurse practitioner has the potential to reduce health services'use in older patients with chronic diseases.

Availability, Range and Utilization of Sexual and Reproductive Health (SRH) Services for Adolescents at Kinondoni Municipality, Dar es Salaam—Tanzania

Background: It is estimated 1.2 billion of world’s population are adolescents aged 10 - 19 years;80% live in developing countries. Adolescents in developing countries especially Sub-Saharan Africa (SSA) face high burden of sexual and reproductive health problems. Sixteen million girls aged 15 to 19 years give birth every year of which 95% occur in low- and middle-income countries. Twenty five percent of unsafe abortions are in 15 - 19 years in Sub-Saharan Africa. Contraceptive use is low as approximately 10% of adolescents are current users. These problems can be averted if different ranges of Sexual and Reproductive Health Services for adolescent (SRHSA) are available and utilized by adolescents. In Tanzania, there is limited information addressing the availability, types and utilization pattern of sexual and reproductive health services by adolescents. This study investigates the availability, range and utilization of sexual and reproductive health services for adolescents (ASRHS) at Kinondoni Municipality, Tanzania. Method: A cross-sectional study was carried out in April to May 2013. A checklist was used to collect information on the availability and range of services offered at selected health facilities. In depth interviews conducted with in-charges of Reproductive and Child Health (RCH) clinics to explore barriers for provision of Sexual and Reproductive Health Services (SRHS) for adolescents. Adolescents were questioned using a questionnaire on utilization of SRHS and perceived barriers. Descriptive statistics were used to summarize quantitative data and content analysis for qualitative data. Results: On availability and range of adolescents’ sexual and reproductive health services, a total of 25 health facilities were surveyed. Forty four percent of the surveyed facilities did not have the adolescent sexual and reproductive health services (ASRHS). The Adolescents Sexual and Reproductive Health (ASRH) services offered differed greatly between facilities. On utilization of adolescents’ sexual and reproductive health services in total, 204 adolescents from the community were involved in this study. A third of adolescents reported to have ever used ASRH. The adolescents perceived barriers for underutilization of the services were fear of being seen at the clinics (23.3%), lack of money (18.3%), lack of privacy & confidentiality (14.2%) and unfriendly health care providers. Three barriers were perceived by health care providers in the provision of ASRHS: integration of SRHS, lack of training in relation to adolescents SRHS and attitudes of health care providers towards young people. Conclusion: About half of the health facilities did not have the SRH-services to adolescent (44%) and different ranges of services were not offered at the facilities as it was shown in the records. The results from this study show services were underutilized by adolescents. Training, attitudes of health care providers towards young people, & cost influenced ASRHS provision and utilization. Strategies to increase training in ASRHS for health providers including communication skills and scaling ASRH services to all primary care facilities may help to improve availability and access of services to adolescents.

Reported Willingness and Associated Factors Related to Utilization of Voluntary Counseling and Testing Services by Female Sex Workers in Shandong Province,China

Objective To explore reported willingness and factors associated with utilization of voluntary counseling and testing services by female sex workers （FSWs） in China and to offer recommendations to optimize use of such services. Methods A questionnaire to explore willingness to use VCT was designed based on social ecological theory and formative qualitative research. A cross-sectional survey was conducted among FSWs from entertainment venues. Single and multiple logistic regression analyses were employed to examine factors associated with reported willingness to utilize VCT. Results A total of 970 FSWs provided valid questionnaires, with 69% （669） expressing willingness to utilize VCT. Factors at the interpersonal level associated with reported willingness included knowledge about VCT, desire to get help if diagnosed as HIV positive, ability to imagine life after an HIV positive diagnosis, and perceived support for VCT from peers, managers, and family members. Availability of free antiretroviral （ARV） treatment represented a factor at policy level. Other factors included intention to leave sex work in the near future, having had a previous HIV test, and lack of a suspected STD history. Conclusions The rate of reported willingness to use VCT among FSWs was substantially higher than that of actual VCT utilization （11%）. The next step is to explore the connection between reported willingness and actual use. Based on these findings, peer education, VCT knowledge dissemination, and free ARV treatment should be emphasized to increase FSWs＇ willingness to use VCT.

Assessment of the Content and Utilization of Antenatal Care Services in a Rural Community in Cameroon: A Cross-Sectional Study

Background: Pregnant women receive antenatal care (ANC) to ensure favorable pregnancy outcomes. Despite the high ANC coverage rate registered nationally in Cameroon;rural women, women with no formal education and those in the most deprived quintile still face difficulties in having access to quality ANC. The impact of the aforementioned factors on ANC use in the Muea Health Area (MHA) is unknown. The objective of this study was to determine the proportion of women attending ANC and the factors influencing ANC attendance in the MHA. Materials and Methods: This was a community based, analytical, cross sectional survey that involved pregnant women and women with children less than two years old who gave an informed consent or assent. Data were collected using a semi structured questionnaire. EPI info Version 7 and Stat Pac for Windows version 12??1998-2011 (Stat Pac Inc, Bloomington, USA) were used for data analysis. Associations were considered statistically significant for p values less than 0.05. Results: Two hundred and twenty women were interviewed. The mean age was 25 years (SD 5.28). Ninety-nine percent of women had at least one ANC visit meanwhile 84.8% had at least four ANC visits. Only 27.2% of women booked for ANC in the first trimester. Rural (Maumu) residence was associated with inappropriate ANC attendance (attending less than four times) (χ2?= 18.5;p = 0.001). Semi urban women (87%;95% C.I. = 85.10% - 89.0%) were more likely to attend four or more sessions than rural (Maumu) women (60.7%;95% C.I. = 44.2% - 77.3%) (p = 0.001). Participant’s educational level was a significant predictor of early booking for ANC (χ2?= 26.8;p = 0.0002). Semi urban wom- en (79.1%;95% C.I. = 76.0% - 82.2%) were significantly more likely to have a vaginal examination done than rural (Maumu) women (42.1%;95% C.I. = 17.5% - 68.2%) (p = 0.0001). Women who met a doctor during ANC (84.0%;95% C.I. = 80.8% - 87.0%) were more likely to have a vaginal examination done than women who only met a nurse or a midwife during ANC (65.0%;95% C.I. = 57.7% - 71.4%) (p = 0.002). One third of women did not have a vaginal examination performed?during ANC. 45.83% and 47.6% neither did a stool test nor received an insecticide treated net (ITN) respectively. Conclusion: Women in the MHA start their antenatal care late, so they should be encouraged to book early for antenatal surveillance. Furthermore, efforts should be made to increase the access of these women to quality ANC services and to adequately trained ANC providers.

Assessment of reproductive health service utilization in urban slums: Evidence from Western Rajasthan

Objective:To assess the utilization of reproductive health services in urban slum of Jodhpur city,India.Methods:A community based cross-sectional study was conducted in an urban slums of Jodhpur city amongst 300 married women of reproductive age between March and June 2021.Semi-structured questionnaire was used to gather demographic data and information about utilization of antenatal care(ANC)services,delivery and post-partum services.Results:The majority of females were aged less than 25 years(n=195;65.0%),married after 18 years(n=240;80%),living in extended families(n=265;88.3%)and with monthly family income less than 10000 rupees(n=182;60.7%).Statistically significant associations were found between≥4 ANC visits and educational level of secondary and above(OR 2.47,95%CI 1.03–6.28;P=0.04),older age(OR 15.70,95%CI 14.87–16.54 for women aged 26-35 years,OR 16.14,95%CI 12.12–20.01 for women aged≥36 years;P<0.01),and backward and general castes(OR 15.91,95%CI 13.57–17.85 for backward caste and OR 8.11,95%CI 8.07–8.26 for general category of caste;P<0.01).Seven percent of females had undergone parturition.Older age was associated with higher risks of postpartum complications(OR 1.06,95%CI 1.01–1.57 for women aged 26-35 years,OR 3.56,95%CI 1.29–4.69 for women aged≥36 years;P<0.01).In addition,risks of postpartum complications were associated with backward and general castes(OR 1.69,95%CI 1.34–2.13 for backward classes and OR 5.01,95%CI 4.29–5.31 for general category castes;P<0.01),and more than 4 ANC visits(OR 0.20,95%CI 0.09–0.34;P<0.01).Conclusions:More frequent ANC visits are associated with a lower risk of postpartum complications.Furthermore,a high utilization of reproductive health services represents good implementation of reproductive and child health programme at the peripheral level resulting in a stark rise in maternal health indicators in the state of Rajasthan.

Health Services Utilization and Health Status of Insured versus Uninsured Nigerian Children with Sickle Cell Disease

Introduction: Nigeria accounts for 150,000 infants born with the Sickle Cell Disease (SCD) every year. Children with SCD are affected by the deleterious effect of user fees which reduces affordability and utilization of health services. Evidences supported that institutionalized health insurance increases intensity of utilization. Methodology: The study was conducted at AKTH, Kano, and north-western, Nigeria. The study was retrospective comparative cross-sectional study. 100 patients were enrolled, 50 for each arm. Paediatric SCD clinic outpatients’ records and a specialty designed form containing the variables of interest were used. Data were analysed using Minitab 16. Proportions, percentages, tables, charts and chi squared test were used to compare the two groups. Result: The study found no association between the two groups in the likelihood of being insured based on age (χ2 = 1.478), gender (χ2 = 0.224) and dwellings (χ2 = 0.062). On health services utilization and insurance status, the study revealed that follow up clinic visits, unscheduled clinic visits and emergency room visits were more likely among the insured group compared to the uninsured group. While the health status and insurance status of the two groups over 12 months period showed a significant association with the insured more likely to have improved health status compared to uninsured (χ2 = 28.019, p = 0.0001). Similarly, health status and health services utilization were significantly associated with insurance status (χ2 = 12.191, p = 0.002). Conclusion: The insurance status of children with SCD is associated with their health services utilization and health status. However, age, gender and dwellings were not associated with insurance status of children with SCD. Therefore, when expanding insurance coverage (NHIS) among children with SCD considerations have to be given to increase health services utilization and resultant improvement in health status as these have the potential of reducing morbidity and mortality among children with SCD.

Impact of the New Cooperative Medical Scheme on Health Care Service Utilization in Rural China

Using the 2000, 2004, and 2006 CHNS longitudinal survey data and econometric methods （random-effect probit regression model and DID methods）, this study conducted an empirical analysis to estimate the impact of NCMS. The major conclusions are as follows. First, predisposing factors, enabling factors, health care need factors, and lifestyle factors affect health care utilization. Second, results using DID methods indicate that NCMS did not affect health care service utilization （outpatient and inpatient） of individuals when ill, but it might increase the possibility of getting a health examination. Third, there is no difference in health care service utilization （both outpatient and inpatient） between the NCMS enrollment group and the non-enrollment group in both working age group （15-59） and the elderly group （60 and over）. Therefore, it can be said that NCMS did not affect the health care utilization in both the group. However, NCMS positively affects disease prevention behavior （visiting the hospital to receive a health examination） in the working age group, but the effect did not appear in the elderly group.

Accessibility and utilization of healthcare services among diabetic patients:Is diabetes a poor man’s ailment?

Diabetes is a non-communicable ailment that has adverse effects on the individual’s overall well-being and productivity in society.The main objective of this study was to examine the empirical literature concerning the association between diabetes and poverty and the accessibility and utilization of medical care services among diabetic patients.The diabetes literature was explored using a literature review approach.This review revealed that diabetes is an ailment that affects all individuals irrespective of socioeconomic status;however,its prevalence is high in low-income countries.Hence,despite the higher prevalence of diabetes in developing countries compared with developed countries,diabetes is not a poor man’s ailment because it affects individuals of all incomes.While the number of diabetic patients that access and utilize diabetes medical care services has increased over the years,some personal and institutional factors still limit patients’access to the use of diabetes care.Also,there is a lacuna in the diabetes literature concerning the extent of utilization of available healthcare services by diabetic patients.

Location Based Services Acceptance and Adoption Evaluation: An Investigation on Mobile Phone Users’ Response to Awareness and Utilization of LBS Technology in Nairobi Kenya

Location Based Navigation System (LBNS) is a specific Location Based Service (LBS) purely for navigational purpose. These systems resolve position of a user by using GNSS/GPS positioning technologies, to which supplementary information on goods and services are tagged. The navigation services have become popular and can be installed on mobile phones to provide route information, location of points of interest and user’s current location. LBS has continued to face challenges which include “communication” process towards user reference. Location Based Service System conveys suitable information through a mobile device for effective decision making and reaction within a given time span. This research was geared at understanding the state of LBS technology acceptance and adoption by users in Nairobi Kenya. To do this a quantitative study was carried out through a questionnaire, to investigate mobile phone users’ response on awareness and use of LBS technology. Testing the growth of this technology in this region compared to predictions in previous studies using Technology Acceptance Model (TAM), it is evident that many users may be aware of GPS functionality in mobile phones but are certainly yet to fully embrace the technology as they rarely use it. This points to some underlying challenges towards this technology within this part of the World, thereby recommending for deliberate monitoring and evaluation of LBS technology for sustenance growth based on user satisfaction and acceptance for improved usability.

Analysis of Inpatient Bed Allocation Equity and Utilization in the City Community Health Service Center of China

The objective of this study was to examine the inpatient bed （IB） allocation equity and utilization in Chinese city commtmity health service centers （CHSCs）. The data were derived from the Baseline Survey of National City Community Health Service System Building Project, which was conducted in 1917 CHSCs in 28 cities in 2007. The IB allocation was analyzed in terms oflB alloca- tion quantity and distribution equity, and the IB utilization was analyzed by the IB utilization rate and average length of stay of the CHSC inpatients. The results showed that 49.3% of the CHSCs were equipped with IB; averagely, there were 45 IBs per CHSC, 0.94 IBs per 1000 people, and 0.38 nurses and 0.57 doctors per IB; the IB Gini coefficient was 0.32; the IB utilization rate was 40.06%; and the average length of stay of inpatients was 12.24 days. The conclusions were that IB allocation among the population was equitable, but the number of nurse per IB was not up to the national standard; and the CHSC IB utilization was low as a whole, thus inpatient service was not the main health service for Chinese CHSCs.

Gender differences in mental health service utilization among respondents reporting depression in a national health survey

This study examined whether people who self-reported depression sought mental health treatment in the year after being interviewed, and how gender affected utilization. Depression data were obtained from the Canadian Community Health Survey (2000-01), and linked to medical records in Ontario (n = 24,677). Overall, women had higher rates of mental health service utilization, but there were no gender differences in rates of specialist care. The gender difference in mental health contact was greater for those without depression, as opposed to those with depression. Among those without depression, women were significantly more likely than men to use mental health services;however, rates were similar for women and men with depression. This finding suggests that men may be more likely than women to delay seeing a doctor for minor mental health concerns, but will seek help once a problem reaches a threshold.

Chronic Diseases, Health Status and Health Service Utilization among Koreans

This study described the self-reported chronic diseases and health status and examined the factors that are associated with effective health service utilization. Descriptive and logistic regression analysis was performed to determine the factors significantly associated with self-rated health, in-patient and out-patient utilization. Self-rated health status was ranked lower among rural residents, lower-income families, married persons, and those with chronic diseases. Chronic diseases such as hypertension, arthritis, melancholy, and diabetes were common and they are associated with poor health of Koreans. The presence of chronic diseases was significant in predicting the likelihood of poor health while socio-economic factors, rather than health-related need factors, had more predictive power of the use of health services. This study provides a unique contribution to the knowledge base of the Korean population. The study findings show that Koreans in poor health status were married, living in rural areas, having chronic diseases and lower income, with a high likelihood of health care utilization among employed individuals, which could significantly help in the public health policy required to address this issue.

Utilization and Felt Need of Oral Health Care Services among Women in Chennai-Descriptive Cross-Sectional Study

Introduction： Oral health is window to overall health. There is a greatest burden of oral diseases on the underprivileged group. In developing countries like India the affordability to oral health care services is very limited thereby leading to poor oral wellness ＆ millions suffer intractable toothache and poor quality of living and end up with few dentition. Objective： To assess the utilization level of oral health services among women in Chennai. Material and methods： A cross-sectional questionnaire survey was conducted among 200 women in Teynampet Zone in Chennai District, Tamil Nadu. The women were chosen by simple random sampling and were interviewed using the semi-stzuctured questionnaire to assess their utilization level during the period of June to July 2016. The data were analyzed by SPSS Version 22. Result： Descriptive statistics and multivariate analysis--MANOVA were used to analyze the utilization level. Majority of the respondents were in the age group of 30-35years, most of the respondents had oral problem and almost everyone had visited dentist at least once within 3 years. Multivariate analysis--MANOVA also showed that the utilization levels were directly influenced by accessibility, availability and affordability and showed statistical significance （p value 〈 0.05） and also from MANOVA analysis it showed that the respondents who had poor oral hygiene did not utilize oral health care services as the affordability was a problem although accessibility and availability was adequate. Conclusion： Our fmdings suggest that people who had oral problem had visited dentist in previous 3 years and most of the people who visited dentist had a good oral hygiene. Cost of the treatment affected the dental visits. They believed that visiting the dentist is necessary only for pain relief.

Development and Utilization of Solar Energy Resources and Meteorological Services in Hami City

Hami City is rich in light resources and is a key area for the development of photovoltaic power generation industry in Xinjiang.In the past 11 years,annual sunshine duration in Hami tended to increase,but annual solar radiation decreased.Sunshine duration and solar radiation were more in summer and less in winter.They were the most in May and the least in December.Meteorological departments should strengthen the observation of illumination and other elements,do a good job in the assessment of solar energy resources and other professional services,and provide technical support for the development and utilization of light energy resources.

Socio-Cultural Barriers Influencing Utilization of Sexual and Reproductive Health (SRH) Information and Services among Adolescents and Youth 10 - 24 Years in Pastoral Communities in Kenya

Background: As in other developing countries, sexual and reproductive ill-health continues to mostly affect adolescents and youths. Samburu and Turkana counties in Kenya have some of the highest levels of total fertility rates (TFR) at 6.3 and 6.9 respectively placing them well above the national TFR of 3.9. Establishing factors that influence utilization of SRH services among adolescent and youth aged 10 - 24 years is critical in developing an effective program. Method: We used primary data from qualitative and purposeful study design. Data collection used Focus group discussions (FGD), In-depth interviews (IDIs) and Key informant interviews (IDIs). The target groups were adolescents and youth aged 10 - 24 years, health care providers, community health volunteers (CHVs), chemist assistants, parents of adolescents and youth, teachers, spiritual leaders and traditional activists. Findings and Conclusion: Socio-cultural factors were found to influence utilization of SRH services and information. Early marriage, being youth, male only decisions on sexuality matters and fear of family contribute to unprotected sex while myths and misconceptions on contraceptives affected utilization. The findings revealed that youth needs to know sources, how contraceptives work and how to use them. The findings suggest capacity building of health care providers, CHVs, teachers, parents and community leaders on adolescence, sexuality needs of adolescents and disadvantages of female genital mutilation (FGM) including early marriage.

Service Delivery Factors That Influence Utilization of HIV Integrated Primary Health Care Programme in Embu Referral Hospital, Kenya

Globally, there are approximately 36.7 million people living with HIV. Integration of HIV treatment with primary care services improves effectiveness, efficiency and equity in service delivery. The study sought to establish service delivery factors that influenced utilization of integrated HIV and primary health care services in Embu Teaching and Referral hospital. A descriptive cross-sectional survey design was used to collect data at a specific period and point of time from a sample of 302 seropositive clients who were selected using simple random method. Data collection tool was structured and semi-structured questionnaire. The tool was reliable at Cronbach’s alpha of 0.817. SPSS version 23 was used to analyze the data. A binary logistic regression model was used to predict the relationship between service delivery and utilization of integrated services. Results: Majority of the respondents (59.6%) were aged over 35 years with majority being female (58.9%) and the married were 57.6% of the total sample. On service delivery factors, majority (94.7%) felt that their health status had improved. Action taken when clients developed side effects, 78.8% reported that the drugs were changed. Action taken following drug side effects significantly affected utilization, χ2 = 1.305, p = 0.001, df = 1. The findings showed that waiting time significantly influenced utilization, χ2 = 9.284, df = 1, p = 0.002. Source of information on self care also significantly influenced utilization, χ2 = 10.689, df = 1, p = 0.001. Kind of treatment at the facility also significantly influenced utilization, χ2 = 5.713, p = 0.048. Conclusion: significant factors that influenced utilization of integrated services were source of health care information, secondly waiting time was another factor which influenced utilization. Majority of the respondents were satisfied with duration of time they take before they were served;they reported to take utmost 1 hour to be attended to and action taken by health care provider following side effects was another factor that influenced the utilization.

The Effect of Funding Cuts on the Utilization of an Oral Pathology Diagnostic Service

Aim To examine what impact the loss of funding had on the utilization of the oral pathology service. Methodology Biopsy records were retrieved and examined in the two year period before and after the elimination of the subsidies in 2003.Results After the loss of fimding, there was a 31% decrease in the number of specimens submitted from practitioners in private practice, with the greatest drop noted in submissions from endodontists. Conclusion Despite the immediate decrease in the number of biopsies submitted after the introduction of fee-for-service, the number of specimens being submitted appears to be on the rise again, as practitioners appear to recognize the value of a specialized oral pathology diagnostic service.

Attendance and Utilization of Antenatal Care (ANC) Services: Multi-Center Study in Upcountry Areas of Uganda

Introduction: Globally every year 529,000 maternal deaths occur, 99% of this in developing coun-tries. Uganda has high maternal and neonatal morbidity and mortality ratios, typical of many countries in sub-Saharan Africa. Recent findings reveal maternal mortality ratio of 435:100,000 live births and neonatal mortality rate of 29 deaths per 1000 live births in Uganda;these still remain a challenge. Women in rural areas of Uganda are two times less likely to attend ANC than the urban women. Most women in Uganda have registered late ANC attendance, averagely at 5.5 months of pregnancy and do not complete the required four visits. The inadequate utilization of ANC is greatly contributing to persisting high rates of maternal and neonatal mortality in Uganda. This study was set to identify the factors associated with late booking and inadequate utilization of Antenatal Care services in upcountry areas of Uganda. Method: Cross-sectional study design with mixed methods of interviewer administered questionnaires, focus group discussions and key informant interviews. Data was entered using Epidata and analyzed using Stata into frequency tables using actual tallies and percentages. Ethical approval was sought from SOM-REC MakCHS under approval number “#REC REF 2012-117” before conducting the study. Results: A total of four hundred one were enrolled with the majority being in the age group 20 - 24 years (mean age, 25.87 ± 6.26). Health workers played a great role (72.04%), followed by the media (15.46%) and friends (12.50%) in creating awareness about ANC. A significant number of respondents went to TBAs with reasons such as “near and accessible”, “my husband decided”, and “they are the only people I know”. 37.63% of the respondents considered getting an antenatal Card as an importance of ANC. 71 (19.67%) respondents gave a wrong opinion (late) on booking time with reasons like demands at work, no problems during pregnancy, advised by friends, just to get a card, long distance and others didn’t know. Almost half of the respondents never knew the recommended number of visits. Religion, occupation, level of education, and parity were found to influence place of ANC attendance, number of ANC visits and booking time. Husbands were necessary to provide financial support, accompany their wives ANC clinic, and ensure that they complete the visits. But their response was poor due to: fear of routine investigations and constrained economically. Conclusion: The study findings show the actual rural setting of ANC services attendance and utilization. Much sensitization has to be done specifically in these rural areas to empower pregnant women and their husbands as to improve ANC attendance and utilization.

Utilization and Satisfaction with HIV Services at 7 Provinces in Vietnam: A Cross-Sectional Study

The study was carried out to determine utilization and satisfaction with essential HIV services from HIV individuals and high-risk populations in 7 socioeconomic provinces nationwide. A cross-sectional approach was applied in the study. Data were collected through face-to-face interviews using self-report questionnaires. Findings from 2380 respondents indicated a high percentage of utilization as well as a high level of satisfaction, in particular among men who have sex with men (MSM) and female sex worker (FSW) sub-group. Needle, syringe, and condom programs had lower usage and satisfaction mean scores in comparison with other services. The proportion of people who used drugs (PWID) and participated in the needle and syringe program was 53.6%. HIV counseling and testing uptake proportion of overall respondents in the last 12 months was 82.2% while the rate of antiretroviral treatment among infected PWID was 74.9%. The level of satisfaction with treatment services was found to be higher than preventive interventions (p < 0.05). Analysis using univariable logistic regression suggested an association between some socioeconomic factors such as income, employment, educational attainment, and marital status with subjects’ satisfaction with several HIV services. Preventive services, especially needle, syringe and condom programs should be prioritized to scale up the coverage and effectiveness. Innovative approaches targeting at PWID should be promoted to increase their access to prevention programs as well as HIV care when needed.