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Regionale variaties in behandeling en ziekenhuisgebruik van dialysepatiënten staan centraal in deze onderzoeksnota. Er wordt gepoogd een algemeen verklaringsmodel van institutionele ziekenhuiszorg uit te tekenen dat deze variaties aan de hand van verschillende determinanten verklaart. Hiertoe werden 363 dialysepatiënten in Antwerpen en Luik ondervraagd en werden hun medische gegevens genoteerd. De resultaten bevestigen het belang van de klinische en socio-demografische situatie en het ziektegedrag van de patiënt, alsmede van de omgeving waarin de behandeling plaatsvindt. De resterende onverklaarde variaties hebben tenslotte de aandacht getrokken op de praktijkstijl van de behandelende geneesheren, een verklaringsfactor waarvan vrijwel geen indicatoren in de vragenlijst opgenomen werden. Het belang van deze factor is eveneens op indirecte wijze tot uiting gekomen in de onderzoeksresultaten.

Abstract Background By focusing upon formal sex education programmes, the Mozambican government has significantly enhanced the general health of adolescents and young adults. However, when it comes to contraception, little is known about how adolescents and young adults actually behave. Methods Based upon a qualitative study in two settings in Maputo province – Ndlavela and Boane – this paper explores the knowledge and practices of contraception among adolescents and young adults. A total of four focus group discussions, 16 in-depth interviews, four informal conversations, and observations were equally divided between both study sites. Results Discrepancies between what adolescents and young adults know and what they do quickly became evident. Ambivalent and contradictory practices concerning contraceptive use was the result. As well, young people had numerous interpretations of risk-taking when not using contraceptives. These inconsistencies are influenced by social and medical barriers such as restricted dialogue on sexuality among adolescents and young adults and their parents and peers. Additionally, ideas about indigenous contraceptives, notions of masculinity and femininity, misconceptions and fear of the side effects of contraceptives, make people of all ages wary of modern birth control. Other barriers include imposed contraceptive choice – meaning no choice, overly technical medical language used at clinics and the absence of healthcare workers more attuned to the needs of adolescents and young adults. Conclusions Adolescents and young adults have numerous – often erroneous – opinions about contraception, leading to inconsistent use as well as vague perceptions of risk-taking. Moreover, social norms and cultural gender roles often contradict and hinder risk-avoiding behaviour. Therefore, in order to improve young people's health, policymakers must address the reasons behind this ambivalence and inconsistency.

Abstract Background Zambia continues to grapple with a high tuberculosis (TB) burden despite a long running Directly Observed Treatment Short course programme. Understanding issues that affect patient adherence to treatment programme is an important component in implementation of a successful TB control programme. We set out to investigate pulmonary TB patient's attitudes to seek health care, assess the care received from government health care centres based on TB patients' reports, and to seek associations with patient adherence to TB treatment programme. Methods This was a cross-sectional study of 105 respondents who had been registered as pulmonary TB patients (new and retreatment cases) in Ndola District between January 2006 and July 2007. We administered a structured questionnaire, bearing questions to obtain individual data on socio-demographics, health seeking behaviour, knowledge on TB, reported adherence to TB treatment, and health centre care received during treatment to consenting respondents. Results We identified that respondents delayed to seek treatment (68%) even when knowledge of TB symptoms was high (78%) or when they suspected that they had TB (73%). Respondent adherence to taking medication was high (77%) but low adherence to submitting follow-up sputum (47%) was observed in this group. Similarly, caregivers educate their patients more often on the treatment of the disease (98%) and drug taking (100%), than on submitting sputum during treatment (53%) and its importance (54%). Respondent adherence to treatment was significantly associated with respondent's knowledge about the disease and its treatment (p < 0.0001), and with caregiver's adherence to treatment guidelines (p = 0.0027). Conclusions There is a need to emphasise the importance of submitting follow-up sputum during patient education and counselling in order to enhance patient adherence and ultimately treatment outcome.