Determinants of utilization of home base care services by the people living with HIV/AIDS in Chadiza District of Zambia

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Mbukwa, Ruth H.
Mbukwa, Ruth H.
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HIV/AIDS is a major public health concern in Zambia. The HIV/AIDS epidemic has placed a large burden on public health facilities that are already functioning with limited resources. This has shifted the burden of care to families and communities, because public health services are often stretched beyond their capacities. Several community home-based care and services evolved in response to the identified need. The reason for carrying out the research was to investigate determinants of utilization of Home-based care services by People above 18 years in Chadiza District Living with HIV/AIDS. The specific objectives were to identify who are the commonest types of home-based care preferred in the community, to determine PLWHA’s level of knowledge about the Home -Based Care services, to determine the demographic characteristics that may influence utilization of HBC services by PLWHA and to establish whether socio-cultural factors influence utilization of Home-Based Care services by PLWHA. The study used a mixed method design. A total of 223 participants took part in the study in Chadiza district at two static and two mobile ART sites for two months and two weeks. Quota sampling was needed to determine the sample of two antiretroviral sites, while convenient sampling was used at ART centres. Purposive type of sampling was used to select the participants for Focus Group Discussions. Quantitative data was analyzed using SPSS 16.0 for windows. Chi square tests were used to determine measures of associations between the independent and dependent variables. Qualitative data was recorded on audio tapes, later transcribed verbatim. The most useful quotations were selected from discussions to summarize main ideas.The study revealed that Home Based Care services for the terminally ill were provided by family members (34.4%; n=223). Most 8 (7.3%;n=223) respondents reported had heard about Home Based Care and were able to correctly define Home Based Care (86.2%; n=223) and were also able to identify correctly the kind of people who are supposed to receive Home Based Care services (92.4%; n=223).The findings showed a statistically significant relationship between knowledge of Home Based Care and client receiving Home Based Care services. Married respondents tended to receive Home Based Care services as compared to the unmarried people and the young. Educational level and occupation of respondents demonstrated a relationship with receiving HBC services. The more educated people were the less likely they are to receiving Home Based Care services. Those who were in formal employment were less likely to receive Home Based Care services than those in non formal and the unemployed such as housewives. Some socio-cultural factors such as religion, sex and service related factors such as availability, accessibility, lack of funding for HBC organizations, general poor quality of service delivery were the major factors identified as very important in the effective utilization of home based services. The study emphasizes that home based care should be spelled out clearly within the new national HIV and AIDS policy (2010-2015) and other relevant policies stressing the care for the terminally ill, caring for caregivers and possible funding by Government through the Ministry of Health.In order to improve performance of HBC services utilization it is necessary to develop robust strategies enhance health education and promote use of HBC’s especially among the highly educated, those who are in formal employment,traditional leaders and general community. The study also identified that vigorous stigma reduction campaigns are a priority if the educated, employed, youth and unmarried PLWHA are to utilize HBC services because these are some of the group that have shown low uptake of his service.. Capacity and system strengthening of HBC organizations such as community based and Non Governmental organizations should be prioritized by donors and other organizations operating in Chadiza District. Most of such Organizations have proved to be very weak in term of capacities hence limiting productivity. Factors Influencing the Study and Literature Review The study was conducted in ART sites and there was need to go to the sites for data collection using a vehicle which were also engaged in other competing District activities. This affected duration for data collection. There was no full funding by the Ministry Health to buy items on the budget for use during the process and financial support to data collecting assistants and this may have influenced data collection in a way.The location Chadiza District has problems in accessing internet to help in information searching. This affected my speed in completing the study and thus prolonged period of study.
Community Health Nursing , Home Care Services , HIV/AIDS-care