Dilemmas and paradoxes in providing and changing antenatal care: a study of nurses and midwives in rural Zimbabwe.

This paper describes the experiences of caregivers in a rural district in Zimbabwe, in caring for pregnant women within a context of changing antenatal care routines. Data were generated using individual interviews with 18 nurses and midwives. The caregivers experienced their working situation as stressful and frustrating due to high staff turnover, inconsistent policies, parallel programmes and limited resources, including time. They also faced difficulties when implementing some of the proposed changes. Furthermore, the caregivers had to deal with the pressure and resistance from the pregnant women, whose reasoning and rationale for using care appeared different from those of the health professionals. In light of the above, we stress the necessity for reflecting on and including the experiences and perspectives of caregivers and the users of care, as well as their contexts and realities, when implementing change.

Health-seeking behaviour of patients with sexually transmitted diseases in Zambia.

The aim of this paper is to describe health-seeking behaviour, time with symptoms and sexual activity during symptom period among patients attending the public health sector in urban and rural Zambia for treatment of an STD. The study was conducted at two urban health centres and at one rural mission hospital during four months in 1994 and 1995. Four hundred and seventy nine patients seeking health care for STD symptoms were interviewed. The patients had experienced STD symptoms for one to two weeks before they came to the clinic. During this period two thirds in the urban and one third in the rural setting had had sex. Sixty per cent of the patients in the urban and 50% in the rural setting had taken some kind of medicine before they came to the clinic. More people had used modern compared to traditional medicine, especially in the urban area. Market places, other clinics and doctors, friends, and relatives were common treatment sources. Ten per cent had received medicine from a traditional healer. Thus, a majority of the patients had received medication from other sources before they came to the clinic. Sex during periods with STD symptoms was common. This has serious implications for STD as well as HIV transmission.

PIP: A number of factors influence which treatment sources people seek when symptoms of morbidity occur and a person alone, or with the advice of others, decides that the condition warrants additional attention. Some such factors are related to social structures such as kinship, social networks, gender, and economic status, while others are related to belief systems which define how people conceptualize the etiology of disease. Service quality, the introduction of user fees, and the cost of treatment can also affect health-seeking behavior (HSB). One highly important factor affecting HSB for sexually transmitted diseases (STD) is social stigma. For example, in Zambia, where STDs are a major public health problem, it is considered highly shameful to have an STD, especially for women. This paper describes the HSB, time with symptoms, and sexual activity during symptom period among patients attending 2 urban public health centers and 1 rural mission hospital in Zambia during 4 months in 1994 and 1995 to receive treatment for their STDs. 479 patients seeking health care for STD symptoms were interviewed. The patients had experienced STD symptoms for 1-2 weeks before coming to the clinic. During that period, two-thirds in the urban and one-third in the rural areas had had sexual intercourse. 60% of the patients in the urban and 50% in the rural settings had taken some kind of medicine before coming to the clinic. However, more people had used modern rather than traditional medicine, especially in the urban area. Marketplaces, other clinics, physicians, friends, and relatives were common treatment sources, although 10% had received medicine from a traditional healer.