m0 x1 ha y54 ff3 fs7 fc0 sc0 ls0 wsc">health care. This can further increase poverty; negatively
impacting on poverty alleviation efforts. Health, there-
fore, holds a key to social and economic development [1].
Understanding human treatment seeking behavior is
essential in changing behavior and improving health
practices. Experts in health interventions and policy have
become increasingly aware of the influence of human
behavioral factors in quality health care provision and
uptake. In order to respond to community perspectives
and needs on diseases of public health importance, health
systems need to adapt their strategies, taking into account
the findings from behavioral studies [9]. Lifestyle and
behavioral change in the treatment seeking pattern can be
influenced through a combination of learning experi-
ences that enhance awareness, increase motivation and
build skills. It is also important to create an environment
that makes positive health practices the easier and more
preferred choice [10].
In any health program, understanding the treatment
seeking behavior of the target community will help in the
design and implementation of interventions that seek to
promote early diagnosis and treatment; help educate the
population on the importance of disease prevention and
correct management; help identify and target facilities for
capacity building (human and infrastructural); and iden-
tify convenient sites for recruiting patients. Knowing a
community’s first treatment option will also help create
and strengthen a resource in the community that can be
used as a patient recruitment and referral point for the
more established and specialized health centers.
1.2. HIV/AIDS, Pharmaceutical Care, and
Human Resources Challenges in
Sub-Saharan Africa
The 1978 Declaration of Alma Ata issued an urgent call
for the world’s nations to focus on primary healthcare
(Alma-Ata, WHO, 1978). Sub-Saharan African (SSA)
countries have had many challenges in increasing access
to universal primary healthcare and the provision of es-
sential medicines [11]. These countries have major hu-
man resource challenges with a large patient to health
service provider ratio despite accounting for a significant
global burden of disease [12]. As at the end of 2009,
there were an estimated 22.5 million people living with
HIV in sub-Saharan, including 2.3 million children [13].
During the same year, an estimated 1.3 million Africans
died from AIDS-related illness with almost 90% of the
16.6 million children orphaned by AIDS living in sub-
Saharan Africa.
At the end of 2009, there were an estimated 1.5 mil-
lion and 1.2 million people living with HIV in Kenya and
Uganda respectively. Although there has been a major
effort to scale up access to HIV treatment, a significant
number of people living with HIV (PLHIV) who are eli-
gible for HIV treatment still lack access [13,14].
The overall goal of ART is to reduce HIV-related
morbidity and mortality as well as improve the quality of
life of the patient. This is achieved through maximal and
sustained suppression of viral load, preservation or res-
toration of the immune function, and prevention of op-
portunistic infections. Recently, the benefits of ART
have been seen in HIV prevention where ART has been
successfully used in prevention of mother-to-child
transmission (PMTCT) while the HIV Prevention Trials
Network Study (HPTN Study 052) reported that initia-
tion of ART protects the uninfected sexual partner from
HIV infection [15]. There is however a challenge in pro-
vision of ART where most patients present for health
care at late stages of the disease with severe immuno-
suppression and thereby reducing the benefits of therapy
and immune recovery [16].
Through understanding a community’s treatment seek-
ing behavior, first line health personnel can be utilized
and strengthened to promote early HIV diagnosis and
prompt timely initiation of ART according to the eligibil-
ity criteria. These health workers can also be used as a
platform for mobilizing and educating the public on key
healthcare issues.
According to the Commission for Africa (2005), SSA
suffers from 25% of the world’s disease burden but has
only 1.3% of the world’s health workforce [17]. Com-
parisons to developed countries are striking; the World
Health Organization (WHO) guidelines recommend a
ratio of 2300 persons to 1 pharmacist. Japan has 22.1
pharmacists per 23,000, France 14.3 per 23,000, Austra-
lia 10.14 per 23,000, and USA 8.58 per 23,000. Liberia,
for example, has just 1 pharmacist per 120,076 people
[17]. Such a large disease burden and shortage of health
personnel puts considerable strain on the available health
workers and the health system. The disparities between
Copyright © 2012 SciRes. WJA
Identifying Treatment and Healthcare Seeking Behavior as a Means of Early HIV/AIDS Intervention in Africa
Copyright © 2012 SciRes. WJA
167
the developed and the developing countries are outlined
in the table below (Table 1).
Recent estimates of the total population of Kenya put
it at a total population of 39.4 million (2009 estimates)
with a gross national income per capita of US$1470 and
a life expectancy of 58.9 years [18]. Infectious diseases
that can be easily controlled and managed, continue to be
a problem in the country; responsible for a significant
level of morbidity and mortality. In 2009 the WHO na-
tional statistics showed that, 106,438 people suffered
from new and relapse cases of TB with 24,435 recorded
deaths from TB in 2007.
Uganda, which shares its eastern border with Kenya, has
a population of 29,899,000 and a gross national income
per capita of US$880. The life expectancy is 51 years [7].
In 2007 there were 28,686 recorded deaths as a result of
Tuberculosis while in 2009, about 40,909 cases of new
and relapse TB cases were reported. According to the
WHO 2004 data, the number one cause of death in devel-
oping countries was lower respiratory infections; condi-
tions that can be easily managed through early diagnosis
and appropriate drug therapy [19].
With such a large disease burden and the poor health
care infrastructure, patients often find themselves with
limited options for treatment. It has been observed in
some communities that although western medical con-
cepts have been assimilated, many patients subscribe to
both traditional and western medical paradigms as a re-
sult of their traditional understanding of illness [20]. Ac-
cording to Matowe et al., the shortage of pharmacists
deprives the population of vital expertise in the manage-
ment of drug related problems in both the community
and hospital settings [21]. As a result, clients make costly
visits to hospitals staffed by overstretched nurses, doctors,
and other staff further burdening an already over-
whelmed system [22]. Because of the increased need for
health care services, an array of healthcare professionals,
allied healthcare workers and others have been known to
acquire, dispense, and in some cases administer medi-
cines [17]. This shift in health care personnel availability
and accessibility is therefore likely to influence treatment
seeking practices in the two countries as well as in many
other sub-Saharan African countries.
In Uganda, as is the case in a number of African coun-
tries, there are more traditional medicine healers than
pharmacists and pharmaceutical care personnel put to-
gether. Table 2 summarizes the population to health care
professional ratios across various African countries to
highlight the severe shortages of health care profession-
als as well as the skewed distribution between urban and
rural communities.
2. Methodology
2.1. Project Setting
This survey was conducted in Busia and Malaba, two
cross-border towns on the common borders of Kenya and
Uganda. These two towns are the busiest crossing points
on this common border and provide transit points for
people and goods to Uganda as well as to several other
East and Central African countries (Rwanda, Burundi,
South Sudan and the Eastern parts of The Democratic
Republic of Congo).
Like in many East African countries, the health care
sectors of both Busia and Malaba are populated by small
pharmacies and drug shops that serve the health care
needs of the population. These drugs hops may be up to
fifteen times more in number than the retail pharmacies.
For the purpose of this write up a drug shop is a facility
that stocks prescription and non-prescription medicines
that is run by a lower-cadre health worker and may or
may not be registered. Table 3 outlines the numbers of
retail pharmacies and drug shops in Kenya, Tanzania and
Uganda.
Table 1. Comparative pharmacist workload for the HIV population for some European and SAA countries.
Country Population Infected AdultsInfected Adults
(Total Population Rate in %)
Infected Adults
(Adult Rate in %)
Infected Persons
per Pharmacist
France 60,140,000 120,000 0.20 0.40 2
Denmark 5,360,000 5000 0.09 0.20 5
Senegal 10,000,000 41,000 0.44 0.80 62
Central African Rep. 3,800,000 240,000 6.73 13.50 223
Kenya 32,000,000 1,110,000 3.75 6.70 625
Botswana 1,785,000 330,000 19.61 37.30 1320
Identifying Treatment and Healthcare Seeking Behavior as a Means of Early HIV/AIDS Intervention in Africa
168
Table 2. SSA pharmacy personnel and population ratios [18].
Name of
Country
Number of
Pharmacists
Population per
Pharmacist
Number of
Pharmacists in
Rural/Urban Area
Has Formal
Pharmacy
Technician Training
Number of
Pharmacy
Technicians/Assistants
Total Number of
Pharmacists and
Technicians
Angola 24 466,283 */* * * *
Benin 11 678,184 0/11 * * *
Botswana 140 11,715 */* Yes 193 333
Burkina Faso 70 198,933 */* * 116 343
Burundi 73 87,269 0/73 * 3 76
Cameroon 950 23,400 70/630 * * *
Chad 31 316,981 5/26 * 6 37
DRC 1200 53,046 360/840 * * *
Equat. Guinea 12 44,657 0/12 * 109 121
Gabon 33 42,097 0/33 * 30 63
Ghana 1388 15,151 */* Yes 1388 2162
Guinea 475 17,864 36/439 * 55 530
Kenya 1861 18,178 */* Yes 1321 1342
Lesotho 17 109,826 */* Yes * *
Liberia 29 120,076 1/28 * 6 35
Malawi 37 328,620 */* * * *
Mali 320 38,411 0/351 * * *
Mozambique 14 1386 */* * 604 618
Namibia 201 10,103 */* Yes 94 288
Niger 20 583,297 2/18 * * *
Nigeria 8642 14,901 */* Yes * *
Rwanda 12 75,364 0/112 Yes 166 278
Senegal 63 176,616 8/* * 22 85
Sierra Leone 84 71,639 */* * 256 340
South Africa 11,097 3996 */* Yes 1424 12,521
Swaziland 46 25,520 0/46 * 24 70
Tanzania 368 100,730 */* * * *
Togo 49 115,949 21/28 * 85 134
Uganda 215 126,835 9/206 * 473 249
Zambia 68 165,615 */* * 332 1039
Zimbabwe 605 21,069 */* Yes 278 883
High health worker mobility and poor record keeping make it challenging to report accurate numbers; these are estimates from various reference sources.
Global Pharmacy Workforce and Migration Report (FIP, 2005); Lockwood, 2005; International Pharmaceutical Federation et al., 2006; WHO 2006;
WHO/AFRO, 2006a, 2006b, 2006c, 2006d, 2006e, 2006f, 2006g, 2006h, 2006i, 2006j, 2006k, 2006l; Losse et al., 2007; International Pharmaceutical Federa-
tion (FIP, 2007a); International Pharmaceutical Federation (FIP, 2007b); *No data available; WHO guidelines recommend 1 pharmacist per population of
2300, WHO Global Atlas, 2006; WHO AFRO, 2006.
Table 3. Pharmacies and drug shops.
Country No of Pharmacies (Retail) No of Drug Shops
Tanzania 780 11,800
Kenya 1250
Uganda 490 5200
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Identifying Treatment and Healthcare Seeking Behavior as a Means of Early HIV/AIDS Intervention in Africa
Copyright © 2012 SciRes. WJA
169
2.1.1. Study Design
A cross sectional descriptive study design was used to
describe treatment seeking behaviors of clients who visit
drug stores.
2.1.2. Data Collection and Analysis
Data was collected from randomly selected drug stores.
The questionnaire was administered by the drug store
operators and was designed to collect information per-
taining to the preferred treatment option, factors that in-
fluence treatment choices, educational background of the
patients, symptoms most commonly reported and the
medication treatment seeking patterns. Patients were also
asked to rank common reasons for selecting treatment
facilities in order of popularity. Epi-info® statistical soft-
ware was used for data management and analysis.
3. Results
Data from this survey were analyzed according to patient
demographics, reasons for seeking treatment, first treat-
ment option as well as common reasons given by patients
for choosing health care providers. A total of 165 drug
shop clients were interviewed. Sixty one percent (97) of
the interviewees were female and 39% (62) were male.
The mean age of the female interviewees was 32.1 years
and 32.7 for males. In terms of patients’ treatment pref-
erences, 67% (n = 165) consulted drug store personnel as
their first treatment option. 33% of the patients had con-
sulted other drug store facilities before coming into the
drug stores where the survey was conducted. Some pa-
tients had consulted more than one facility for the very
same condition, 20% (of the 165 patients that partici-
pated in the survey) had first been to a clinic or hospital,
5% had been to a pharmacy, and 8% had first sought help
from a traditional healer (Figure 1).
Patients who had sought treatment from other facilities
before coming into the drug stores came in either because
there was no response to treatment (39% n = 65) or be-
cause the condition had worsened (53% n = 88).
About 7.5% (12) had never been to school; 37.7% (60)
had attained a primary school level education. About
28% (n = 159) of the drug store interviewees had a terti-
ary-level qualification. The level of academic qualifica-
tion of the interviewees can be seen in Figure 2.
With regards to the reasons and time of visiting the
drug store, 72.2% of patients interviewed (N = 165) re-
ported that the main reason for visiting the drug store
was because they were “sick”. The most common pre-
senting symptom were headaches (40.6%, N = 165) fol-
lowed by recurrent fevers and sweats (33.3%, N = 165).
Fifty-nine patients (35.8%, N = 165) came in for family
planning services and advice on condom use. Fifteen
point four (15.4%, N = 165) of the patients complained
of recurrent diarrhea, 15.4% of genital discharge and
11.5% of genital pain. Eighteen of the patients suffering
from recurrent fever only consulted the drug stores after
at least five days of being sick. The diseases and symp-
toms presented by the patients on contact with the drug
store are summarized in Table 4.
Figure 1. First treatment option.
Figure 2. Educational qualification of interviewees (n = 165).
Table 4. Symptoms patients presented with upon arrival to
the facilities.
Reason given Number of
respondents Percentage
Headache 67 40.6%
Family planning 59 35.8%
Recurrent fever/sweating 55 33.3%
Persistent cough 27 16.4%
Recurrent diarrhea 26 15.8%
Genital discharge 26 15.8%
Skin condition 25 15.2%
Genital lesions/sores 22 13.3%
Rapid weight loss 19 11.5%
Pelvic/Genital pain 19 11.5%
HIV and AIDS medication 19 11.5%
Chronic conditions 18 10.9%
White spots in the mouth 12 7.3%
Swollen lymph nodes 5 3.0%
Diagnosed TB patients 5 3.0%
Total 165 100%
Identifying Treatment and Healthcare Seeking Behavior as a Means of Early HIV/AIDS Intervention in Africa
170
At the time of visiting the drug stores, 35.8% of the
patients had been sick for 2 - 4 days, 15.8% had been
sick for 5 - 10 days while 14.5% had been sick for up to
two weeks. Clients who came in for family planning and
for chronic medication refills accounted for 7.3% and
12.1% of the patients respectively. The number of days
that people waited before seeking treatment for their
condition is illustrated in Table 5.
The use of both traditional and western medicine, al-
though practiced at a smaller scale, is still an important
factor in treatment. Although only 8% of the interviewed
patients reported having first gone to a traditional healer,
41.25% of 165 interviewees reported having previously
used traditional medicines for various conditions. 20%
admitted having taken traditional medicines concurrently
with conventional pharmaceuticals. There was no appar-
ent direct relationship between educational level and the
use of traditional medicines. Of the 62 patients who re-
ported having used traditional medicines, 30.6% of the
patients had a tertiary-level qualification, 30.6% had a
secondary school qualification, 30.6% had a primary
school qualification and 8% had had no formal education.
The patients reported various reasons for choosing the
facility over others. 24.3 % reported that it was because
of the distance to the facility; 21.2% for quality and
availability of service; 12.6% for absence of user fees;
10% on attitude of health personnel towards patients;
9.5% availability of drugs; 9.2% easy access to health
care personnel; 6.7% privacy and confidentiality; 4.5%
availability of other services and 1.9% the speed of ser-
vice delivery.
4. Discussion
In most SSA countries, the governments are largely re-
sponsible for provision of healthcare to the population [23].
However, universal access to health remains a great chal-
lenge mainly driven by a severe shortage of health per-
sonnel and poorly developed health infrastructure [24].
Even where there are some available health services, the
distribution is usually skewed towards urban areas [25].
Table 5. Duration of sickness before seeking treatment.
Days while sick Number of respondent Percent
1 day 10 6.1%
2 - 4 days 59 35.8%
5 - 10 days 26 15.8%
10 - 14 days 24 14.5%
Chronic condition 20 12.1%
Family planning 12 7.3%
Not specified 14 8.5%
Total 165 100.00%
The HIV epidemic has had a significant impact on the
health systems and its capacity to provide healthcare to
the population [26]. HIV infected individuals are more
likely to suffer from infectious diseases by virtue of the
compromised immunity and therefore require more fre-
quent medical attention in the health facilities. This ulti-
mately increases patient volumes and thereby over-
whelming the few available health workers. Secondly,
there is the direct impact on the health worker who gets
infected and leading to reduced ability to discharge their
roles and ultimately loss through death [27].
Additionally, there is an increasing demand for re-
sources to train health workers since additional skills and
capacity is consistently required to ensure continued
quality of care [28]. All these facts contribute to long
queues and waiting times at most clinics and hospitals.
The results of the survey present several interesting in-
sights on the treatment seeking behavior of individuals in
the study community. The community drugstores are a
major source of healthcare in rural and peri-urban com-
munities. Of the 165 individuals participating in the sur-
vey 67% reported visiting the drugstore as the first point
of call. The survey also revealed that there were other
reasons for visiting the drugstores beyond illness. It was
reported that 17.8% of the respondents had visited the
drugstore for information and supply of family planning
methods as well as purchase of condoms. This indicates
that drugstores can play an important role in dissemina-
tion of information on issues of public health concern in
the community.
4.1. Gender and Treatment Seeking Behavior
The survey showed that there was utilization of services
in the drugstores by community members from both
genders although there were higher numbers of females
participating in the survey. A population-based study
conducted in Nairobi, Kenya showed major gender dif-
ferences in proportions seeking care for STIs and that
majority of men and women sought STI care in private
health facilities including community pharmacies [29].
These findings illustrate the important role that private
facilities play in the provision of health care in many
African communities. There have however been ques-
tions about the quality of services available in these fa-
cilities despite perception of high quality among their
clients [30]. It is therefore important to put in place
mechanisms to improve the quality and appropriateness
of services.
4.2. Influence of Level of Education on
Treatment Seeking
The findings of the survey indicated that the patients vis-
iting drugstores had varied levels of education ranging
Copyright © 2012 SciRes. WJA
Identifying Treatment and Healthcare Seeking Behavior as a Means of Early HIV/AIDS Intervention in Africa 171
from no formal education to tertiary level. The level of
education did not seem to affect utilization of traditional
medicines. However, some studies have reported an in-
crease in utilization of western medicines and improved
health with increasing maternal education [31,32]. Drug-
stores, by virtue of serving a significant portion of the
population, present a major opportunity to increase ac-
cess to health information. However, taking into consid-
eration the varied levels of education of the clientele, it is
important that materials and information provided be
easily understood irrespective of the level of education
and the language used.
4.3. Reasons for Visiting
The patients/clients visiting the drugstores presented with
various reasons for visiting the facility. These services
include treatment for minor ailments, family planning,
recurrent fever, sexually transmitted infections (STI),
diarrhea and respiratory tract infections. This clearly in-
dicates that the patients expect to receive a range of ser-
vices comparable to what is available in the public facili-
ties. However, these drugstores are not mandated by law
to provide the whole range of services [33]. To ensure
that the patients access quality and appropriate informa-
tion and services from drug stores, it is important that the
drugstore personnel recognize their limitations in terms
of skills and knowledge and have mechanisms that can
facilitate referral for more specialized services. Addi-
tionally, the range of services allowed in these facilities
should be reviewed and appropriate training provided.
4.4. Why Preference for Drugstores
The findings of the survey indicated several reasons why
the patients visited the drugstores for health services and
the reasons for the preference [34]. Closer proximity of
the drug store seemed to be the major consideration for
opting to seek health services from these facilities. Other
reasons included perceptions of better quality and avail-
ability of services, more friendly health providers, avail-
ability of medicines, better privacy and confidentiality,
and faster services.
Several studies have demonstrated that individuals
prefer use of private health institutions including drug
stores for various health services through self-medication
and consultation with the drugstore personnel. Some of
the services sought in the drugstores include treatment
for sexually transmitted diseases, family planning [35],
malaria treatment [36], childhood diseases (including
diarrhea and acute respiratory infections) [36]. This in-
dicates that there are a lot of health issues that drug store
operators are presented with as they do business and in-
teract with the community. However, it is doubtful that
these drugstore personnel have the necessary skills and
knowledge to effectively provide these services.
5. Study Limitations
The survey does not represent a random sample of pa-
tients in the community consulting all the health care
facilities. The questionnaire was administered to patients
who came into the drug shop only.
6. Conclusions
From the survey and other published literature, it is evi-
dent that drugstores are a major contributor to healthcare
for the population in Sub-Saharan Africa. Although the
quality of service may not be optimal, these cadres of
health care workers can be properly trained and inte-
grated in disease prevention and management strategies.
If properly managed and supported, drug store per-
sonnel can play an important part in dissemination of
important health information and increase access to and
utilization of services for public health intervention pro-
grams including HIV and AIDS, malaria, tuberculosis
and, child and maternal health. They can be used in the
implementation of interventions that seek to promote
early diagnosis and treatment; help educate the popula-
tion on the importance of disease prevention and correct
management; help educate patients on the prevention of
HIV; address some of the myths surrounding HIV and
AIDS as well as condom use. Drug store personnel are
therefore a good target for the capacity building of health
care personnel and are convenient sites for recruiting
patients for community education programs. By devel-
oping the human resource personnel at the drug store level,
many patients’ treatment outcomes will be improved.
7. Acknowledgements
This article is made possible by the support of the
American People through the United States Agency for
International Development (USAID). (Grant No. 621-A-
00-08-00067-00). The contents of this article are the sole
responsibility of the authors and do not necessarily re-
flect the views of USAID, the United States Government
or Howard University.
REFERENCES
[1] P. A. Bourne, “Impact of Poverty, Not Seeking Medical
Care, Unemployment, Inflation, Self-Reported Illness,
and Health Insurance on Mortality in Jamaica,” North
American Journal of Medical Sciences, Vol. 1, No. 3,
2009, p. 99.
[2] S. M. Ahmed, “Exploring Health-Seeking Behaviour of
Disadvantaged Populations in Rural Bangladesh,” Karo-
linska University Press, Stockholm, 2005.
http://www.bracresearch.org/publications/thesis_masudbh
ai.pdf
Copyright © 2012 SciRes. WJA
Identifying Treatment and Healthcare Seeking Behavior as a Means of Early HIV/AIDS Intervention in Africa
172
[3] A. Grover, R. Kumar and S. K. Jindal, “Socio-Demo-
graphic Determinants of Treatment-Seeking Behavior
among Chest Symptomatics,” Indian Journal of Commu-
nity Medicine, Vol. 31, No. 3, 2006, pp. 145-149.
[4] E. M. Malik, K. Hanafi, S. H. Ali, E. S. Ahmed and K. A.
Mohamed, “Treatment-Seeking Behaviour for Malaria in
Children under Five Years of Age: Implication for Home
Management in Rural Areas with High Seasonal Trans-
mission in Sudan,” Malaria Jo urnal, Vol. 5, No. 1, 2006,
p. 60. http://www.malariajournal.com/content/5/1/60
[5] T. M. Ola, F. O. Aladekomo and B. A. Oludare, “Deter-
minants of the Choice of Treatment Outlets for Infertility
in Southwest Nigeria,” Rawal Medical Journal, Vol. 33,
No. 2, 2008, pp. 193-196.
http://www.scopemed.org/?jft=27&ft=27-1304694550
[6] Z. Abdu, Z. Mohammed, I. Bashier and B. Eriksson, “The
Impact of User Fee Exemption on Service Utilization and
Treatment Seeking Behaviour: The Case of Malaria in
Sudan,” The International Journal of Health Planning
and Management, Vol. 19, No. S1, 2004, pp. S95-S106.
[7] World Health Organization, “Countries,” 2012.
http://www.who.int/countries/en/
[8] J. Chuma and C. Molyneux, “Treatment-Seeking Behav-
iour, Cost Burdens and Coping Strategies among Rural
and Urban Households in Coastal Kenya: An Equity
Analysis,” Tropical Medicine & International Health,
Vol. 12, No. 5, 2007, pp. 673-686.
[9] S. Hausmann-Muela, J. M. Ribera and I. Nyamongo,
“Health-Seeking Behaviour and the Health System Re-
sponse,” DCPP Working Paper No. 14, 2012.
http://www.dcp2.org/file/29/wp14.pdf
[10] M. P. O’Donnell, “Definition of Health Promotion,” Amer-
ican Journal of Health Promotion, Vol. 1, No. 1, 2009,
pp. 4-5.
[11] I. P. Chudi, “Healthcare Problems in Developing Coun-
tries,” Medical Practice and Reviews, Vol. 1, No. 1, 2010,
pp. 9-11.
[12] World Health Organization, “Disease Incidence, Preva-
lence and Disability,” 2012.
http://www.who.int/healthinfo/global_burden_disease/20
04_report_update/en/index.html
[13] AVERT, “Sub-Saharan Africa HIV & AIDS Statistics,”
2012. http://www.avert.org/africa-hiv-aids-statistics.html
[14] A. R. Maddison and W. F. Schlech, “Will Universal Ac-
cess to Antiretroviral Therapy Ever Be Possible? The
Health Care Worker Challenge,” Canadian Journal of
Infectious Diseases & Medical Microbiology, Vol. 21, No.
1, 2010, pp. 64-69.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2852293/
pdf/idmm21e064.pdf
[15] HPTN Press, “Initiation of Antiretroviral Treatment Pro-
tects Uninfected Sexual Partners from HIV Infection
(HPTN Study 052),” 2012.
http://www.hptn.org/web%20documents/PressReleases/H
PTN052PressReleaseFINAL5_12_118am.pdf
[16] Y. Abaynew, A. Deribew and K. Deribe, “Factors Asso-
ciated with Late Presentation to HIV/AIDS Care in South
Wollo ZoneEthiopia: A Case-Control Study,” AIDS Re-
search and Therapy, Vol. 8, No. 1, 2011, p. 8.
http://www.biomedcentral.com/content/pdf/1742-6405-8-
8.pdf
[17] R. King and H. Fomundam, “Remodeling Pharmaceutical
Care in Sub-Saharan Africa (SSA) Amidst Human Re-
sources Challenges and the HIV/AIDS Pandemic,” The
International Journal of Health Planning and Manage-
ment, Vol. 25, No. 1, 2010, pp. 30-48.
doi:10.1002/hpm.982
[18] Kenya National Bureau of Statistics (KNBS) and ICF
Macro, “Kenya Demographic and Health Survey 2008-
09,” KNBS Nairobi, and ICF Macro, Maryland, 2009.
[19] World Health Organization, “The Top 10 Causes of
Death,” 2012.
http://www.who.int/mediacentre/factsheets/fs310/en/inde
x.html
[20] J. E. Macfarlane and M. P. Alpers, “Treatment-Seeking
Behaviour among the Nasioi People of Bougainville:
Choosing between Traditional and Western Medicine,”
Ethnicity & Health, Vol. 14, No. 2, 2009, pp. 147-168.
http://www.informaworld.com/smpp/516690265-786151
92/title~db=all~content=t713421971~tab=issueslist~bran
ches=14 - v1414
[21] L. Matowe, M. Duwiejua and P. Norris, “Is There a Solu-
tion to the Pharmacist Brain Drain from Poor to Rich
Countries?” Pharmac eut ic al Jo urnal , Vol. 272, No. 7283,
2004, pp. 98-99.
[22] D. R. Katerere and L. Matowe, “Effect of Pharmacist
Emigration on Pharmaceutical Services in Southern Af-
rica,” American Journal of Health-System Pharmacy, Vol.
60, No. 11, 2003, pp. 1169-1170.
[23] Ministry of Health, “Reversing the Trends: The Second
National Health Sector Strategic Plan of Kenya,” 2012.
http://www.nacc.or.ke/attachments/article/102/NHSSP%2
0II-2010.pdf
[24] World Health Organization, “World Health Report 2006:
Working Together for Health,” 2012.
http://www.who.int/whr/2006/whr06_en.pdf
[25] Africa Health Worker Observatory (AHWO), “Human
Resources for Health Country Profile (Kenya),” 2012.
http://www.hrh-observatory.afro.who.int/images/Docume
nt_Centre/kenya_country_profile.pdf
[26] National AIDS and STI Control Programme, “AIDS in
Kenya: Trends Interventions and Impact,” 7th Edition,
NASCOP, Nairobi, 2005.
[27] L. Tawfik and S. Kinoti, “The Impact of HIV/AIDS on
Health Systems and the Health Workforce in Sub-Saharan
Africa: SARA Project,” United States Agency for Inter-
national Development, Bureau for Africa, Washington,
2003.
[28] E. A. McCarthy, M. E. O’Brien and W. R. Rodriguez,
“Training and HIV-Treatment Scale-Up: Establishing an
Implementation Research Agenda,” PLoS Medicine, Vol.
3, No. 7, 2006, p. e304.
doi:10.1371/journal.pmed.0030304
[29] H. A. C. M. Voeten, J. M. Otido and H. B. O’Hara.
“Quality of Sexually Transmitted Disease Case Manage-
ment in Nairobi, Kenya: A Comparison among Different
Copyright © 2012 SciRes. WJA
Identifying Treatment and Healthcare Seeking Behavior as a Means of Early HIV/AIDS Intervention in Africa
Copyright © 2012 SciRes. WJA
173
Types of Healthcare Facilities,” Sexually Transmitted
Disease, Vol. 28, No. 11, 2001, pp. 633-642.
doi:10.1097/00007435-200111000-00005
[30] C. N. Morris and A. G. Ferguson, “Sexual and Treat-
ment-Seeking Behaviour for Sexually Transmitted Infec-
tion in Long-Distance Transport Workers of East Africa,”
Sexually Transmitted Infections, Vol. 83, No. 3, 2007, pp.
242-245.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2659098/
?tool=pmcentrez
[31] S. Karlsen, L. Say, J. Souza, C. J. Hogue, D. L.Calles, A.
M. Gülmezoglu and R. Raine, “The Relationship between
Maternal Education and Mortality among Women Giving
Birth in Health Care Institutions: Analysis of the Cross
Sectional WHO Global Survey on Maternal and Perinatal
Health,” BMC Public Health, Vol. 11, No. 1, 2011, p. 606.
doi:10.1186/1471-2458-11-606
[32] C. McAlister and T. F. Baskett, “Female Education and
Maternal Mortality: A Worldwide Survey,” Journal of
Obstetrics and Gynaecology Canada, Vol. 28, No. 11,
2006, pp. 983-990.
http://www.sogc.org/jogc/abstracts/full/200611_womensh
ealth_3.pdf
[33] A. K. Mbonye, R. Ndyomugyenyi, P. Magnussen, S.
Clark and C. Chandler, “The Feasibility of Introducing
Rapid Diagnostic Tests for Malaria in Drug Shops in
Uganda,” Malaria Journal, Vol. 9, No.1, 2010, p. 367.
doi:10.1186/1475-2875-9-367
[34] J. Stanback, C. Otterness, M. Bekiita, O. Nakayiza and A.
K. Mbonye, “Injected with Controversy: Sales Admini-
stration Of Injectable Contraceptives in Drug Shops in
Uganda,” International Perspectives on Sexual and Re-
productive Health, Vol. 37, No. 1, 2011, pp. 24-29.
http://www.guttmacher.org/pubs/journals/3702411.pdf
[35] E. Patouillard, K. G. Hanson and C. A. Goodman, “Retail
Sector Distribution Chains for Malaria Treatment in the
Developing World: A Review of the Literature,” Malaria
Journal, Vol. 9, No. 1, 2010, p. 50.
doi:10.1186/1475-2875-9-50
[36] Y. Tawfik, J. Nsungwa-Sabitii, G. Greer, J. Owor, R.
Kesande and S. Prysor-Jones, “Negotiating Improved
Case Management of Childhood Illness with Formal and
Informal Private Practitioners in Uganda,” Tropical Medi-
cine & International Health, Vol. 11, No. 6, 2006, pp.
967-973. doi:10.1111/j.1365-3156.2006.01622.x