The patient-provider relationship and antenatal care uptake at two referral hospitals in Malawi: A qualitative study

Background In post-stroke patients, impairment of quality of life (QOL) has been associated with functional impairment, age, anxiety, depression, and fatigue. Good social support, higher education, and better socioeconomic status are associated with better QOL among stroke survivors. In Africa, studies from Nigeria and Tanzania have reported on post-stroke QOL. Background Approximately 90% of Malawian women attend antenatal care at least once during their pregnancies; however, most mothers first present during months five and six and do not adhere to the World Health Organization’s recommended four visits. The objective of this study was to explore the role the patient-provider relationship has on antenatal care uptake. Methods A qualitative study, consisting of interviews with 20 urban pregnant mothers and eight health workers, was conducted from September to December 2014. Two large tertiary care hospitals in the Central and Southern regions of Malawi were selected as study sites. Results Several factors influenced antenatal care attendance. Significant barriers reported included the patient-provider relationship, clinic wait times, family and friend support, distance from home to the clinic, transportation, cost, and number of visits. The patient-provider relationship appears to have a large impact on antenatal clinic participation. Mothers indicated that health workers often mistreat or demean them during visits. Additionally, health workers revealed that, due to staff shortages, patients often do not receive the care they deserve. Conclusions The results of this study suggest that, in addition to other factors, healthcare provider attitudes influence antenatal clinic attendance. Improving the patient-provider relationship may increase antenatal clinic attendance and decrease pregnancy complications during pregnancy. Professional development opportunities and quality improvement programmes are would help improve patient care and health outcomes while the continued staff shortages in the country are addressed.

A PRELIMINARY SURVEY OF ANIMAL HANDLING AND CULTURAL SLAUGHTER PRACTICES AMONG KENYAN COMMUNITIES: POTENTIAL INFLUENCE ON MEAT QUALITY

Kenya is composed of over 40 ethnic communities who practice varied methods of animal handling and slaughter. Socio-cultural and religious traditions have the potential to influence animal handling and slaughter practices. These influences have, however, not been documented in the literature as far as the author is aware. Also, the literature has documented the connection between the manner of animal treatment and meat quality, but this is rarely discussed in the literature in Kenya; this connection is important as it informs modern meat trade practices by Kenyans as they trade in the global arena. This survey aimed to mainly establish and document the animal slaughter practices among Kenyan communities, and, to also highlight any current provisions related to meeting modern animal welfare requirements, animal handling procedures in the meat trade and discuss their potential influence on meat quality available in commerce in Kenya. This preliminary study surveyed the slaughter practices among 10 different Kenyan communities through a semi-structured questionnaire, focus group discussions and individual interviews. The survey demonstrated that different Kenyan communities practice varied methods of animal slaughter depending on whether the animal being slaughtered is for public feasting, domestic consumption or commercial merchandizing. The Kenyan communities surveyed in this study depend mainly on males to slaughter livestock for females preparing it for domestic use using a number of instruments and methods. For small stock for domestic consumption, females may slaughter the animal except for Muslims whose males have to slaughter the animal with a special knife (a Khalef) according to Muslim rites to render it Halal. Large stock is invariably slaughtered by males irrespective of the community, and the manner of use of the carcass. Gender, age, religion, community and the size of the animal were the major determinants of the method of animal slaughter. The animal welfare issues highlighted in the survey and related to the handling and slaughter of livestock have important implications for meat quality during commercial merchandizing. There is an apparent need to provide education to herders, livestock handlers, employees and management in the livestock industry in Kenya on the relationship between animal welfare requirements, animal handling procedures and meat quality. Such awareness can potentially improve the quality and economic value of the meat available in commerce.

Impact of dental caries on quality of life of adolescents according to access to oral health services: a cross sectional study

Aim: This study presents the prevalence of dental caries and its relation to the quality of life of adolescents according to the access to dental health services. Methods: Two hundred and fifty-six adolescents between 15 and 19 years of age participated in the study; they were all enrolled in public schools in a countryside municipality of the São Paulo State. Data related to dental caries were evaluated by the DMFT Index, and OHIP-14 was used for evaluating the quality of life. Mann Whitney and Spearmann correlation tests were also used (p<0.05). Results: A DMFT of 3.09 (±3.30) was found with a higher prevalence among the adolescents who used public dental services (3.43±3.34) compared with those who used private services (2.94±3.28). A statistically significant relationship between the decay component of DMFT with physical pain (0.020), physical disability (0.002) and quality of life (0.017) was verified. Conclusions: A low prevalence of dental caries was observed, and it was higher in adolescents who used public oral health services rather than private ones, evidencing the low influence of oral health on the quality of life of the participants.