Non-use of Formal Health Services in Malawi: Perceptions from Non-users

Background The study upon which this paper is based was undertaken to understand users’ and non-users’ perceptions concerning facilitators and barriers to equitable and universal access to health care in resource-poor countries such as Malawi. In this study, non-users of health services were defined as people who were not in need of health services or those who had stopped using them due to significant barriers. Methods A total of 80 interviews with non-users of health services were conducted in Rumphi, Ntchisi, Phalombe and Blantyre Districts of Malawi. Interviews focused on why informants were not using formal health services at the time of data collection. In order to identify non-users, snowballing was used health surveillance assistants, village headmen and community members also helped. One focus group discussion was also conducted with non-users of health services who were members of the Zion Church. Results Informants described themselves as non-users of health services due to several reasons: cost of health services; long distances to health facilities; poor attitude of health workers; belief in the effectiveness of traditional medicines; old age and their failure to walk. Others were non-users due to their disability; hence they could not walk over long distances or could not communicate effectively with health providers. Some of these non-users were complete non-users, namely members of the Zion Church and those who believed in traditional medicine, and they stated that nothing could be done to transform them into users of health services. Other non-users stated that they could become users if their challenges were addressed e.g. for those who were non-users of health services due to poor attitudes of health workers, they stated that if these health workers were transferred they would be able to access health services. Conclusions Public health education targeting both health workers and non-users, ensuring a functional outreach program and addressing other health system challenges such as shortage of drugs and human resources would assist in transforming non-users into users of health services.

Erosive potential of sugar-free hard candies dissolved in water and artificial saliva

Aim: To compare the acidity of sugar-free hard candies dissolved in water and artificial saliva. Methods: Sugar-free Flopi Florestal hard candies (grape, strawberry, cherry, orange, ginger, lemon balm, fennel) were selected and grouped in 2 groups: G-1 (candies dissolved in distilled water) and G-2 (candies dissolved in artificial saliva). Candies were triturated with a porcelain pestle, yielding two samples of 20 g. Samples were dissolved in 120 mL distilled water (G-1) and 120 mL artificial saliva (20 mM NaHCO3, 3 mM NaH2PO4.H2O and 1 mM CaCl2.2H2O) (G-2), obtaining three samples of 30 mL for each of the flavors and groups. pH was measured using potentiometer and combined glass electrode. Titratable acidity was evaluated by adding 100 μL 1M NaOH aliquots until reaching pH 5.5. For statistical analysis, analysis of variance (ANOVA) was used. Means were compared by the Tukey test at 5% significance level (p<0.05) Results: All flavors of G-1 showed pH values below 5.5. Comparison of groups in the same flavor showed a significant increase in pH in flavors of G-2. Comparison of the titratable acidity between G-1 and G-2, showed that fruit flavors were significantly different from each other, with reduced acidity in G-2. Conclusions: All evaluated candies are acid, and dilution in artificial saliva raised their pH and lowered their titratable acidity, reducing their erosive potential.

Select toxic metals status of pregnant women with history of pregnancy complications in Benin City, South-South Nigeria.

Toxic metals are part of the most important groups of environmental pollutants that can bind to vital cellular components and interfere with their functions via inhalation, foods, water etc. The serum levels of toxic metals (lead, mercury, cadmium and arsenic) in pregnant women with history of pregnancy complications, pregnant women without history of pregnancy complication and non-pregnant women in Benin City, South – South Nigeria was investigated in this paper, with total of 135 healthy women comprising of 45 pregnant women with history of previous pregnancy complications, 45 pregnant women without history of pregnancy complications and 45 non-pregnant women without history of pregnancy complications (controls). Some demographic characteristics and 4ml of blood samples were obtained from each subject for the analysis of lead, mercury, cadmium and arsenic by standard methods. Pregnant women with history of pregnancy complications recorded a highly significant increase in the toxic metal (lead) mean value of 25.81μg/dl as against 23.70μg/dl for pregnant women without history of pregnancy complications and 11.23μg/dl for non-pregnant (control) women without history of pregnancy complications as well as significant increases in the mean values of other toxic metals (mercury, cadmium and arsenic) compared with controls (p<0.001). The selected toxic metals (Pb, Hg, Cd and As) may be involved in the development of pregnancy complications among pregnant women in Benin City, South– South Nigeria. Lead in particular may pose threat to mothers and fetuses as its mean values in the two groups of pregnant women were well above normal.