DETERMINANTS OF ROUTINE MEDICAL EXAMINATION AMONG THE COMMUNITY OF NTAAWO VILLAGE, MUKONO DISTRICT

DEFINITION OF TERMS

Personal determinants: are the individual determinants that strongly influence their behaviors.

Social Economic determinants: this refers to how economic affects and is shaped by social processes. In general it analyzes how societies progress, stagnate, or regress because of their local or regional economy, or the global economy.

Health facility related determinants: are determinants that affect individuals within the health facility.

A medical examination (more popularly known as a check-up) is the process by which a medical professional investigates the body of a patient for signs of disease.

ABBREVIATIONS/ACRONYMS

HEENT:        Head, Eye, Ear, Nose and Throat

HIV:              Human Immune deficiency Virus

LC:                 Local council

MoH:             Ministry of Health

PHAC:           Public Health Agency of Canada

RCT:              Routine Counseling and Testing

UBOS             Uganda Bureau of Statistics

UDHS:           Uganda Demographic and Health Survey

UNFPA:         United Nations Family Planning Association

UNMEB:      Uganda Nurses and Midwives Examination Board

USA               United States

USPSTF:       US Preventive Services Task Force Guidelines

VHT:              Village Health Team

WHO:            World Health Organisation

CHAPTER ONE

INTRODUCTION

This chapter presents the background of the study, problem statement, purpose of the study, specific objectives, research questions and justification of the study.

1.1 Background of the study

A medical examination (more popularly known as a check-up) is the process by which a medical professional investigates the body of a patient for signs of disease. It generally follows the taking of the medical history an account of the symptoms as experienced by the patient. Together with the medical history, the medical examination aids in determining the correct diagnosis and devising the treatment plan. This data then becomes part of the medical record (Krogsboll et al., 2012).

Routine medical examinations performed on asymptomatic patients for medical screening purposes, these are normally performed by a pediatrician, family practice physician, physician assistant, a certified nurse practitioner or other primary care provider. This routine medical exam usually includes the Head, Eye, Ear, Nose and Throat (HEENT) evaluation. Nursing professionals such as Registered Nurse, Licensed Practical Nurses develop a baseline assessment to identify normal versus abnormal findings. These are reported to the primary care provider (Verghese, 2011).

A medical examination may include checking vital signs, including temperature examination, Blood pressure, pulse, and respiratory rate. The healthcare providers use the senses of sight, hearing, touch, and sometimes smell (in infection, uremia, and diabetic ketoacidosis). Taste has been made redundant by the availability of modern lab tests. Four actions are taught as the basis of medical examination: inspection, palpation (feel), percussion (tap to determine resonance characteristics), and auscultation (Guadalajara, 2015).

Although the health implications of communities’ underutilization of health services such as routine medical examination are not fully understood, they coincide with them living shorter lives and perishing from preventable conditions at higher rates. Thus, even as the value of routine health examinations is being debated, it may be important to unearth determinants motivating communities to schedule and obtain them (Link and Phelan, 2008).

The social determinants of health differ depending on the social, economic, political, cultural and physical climate within which they exist. According to the Public Health Agency of Canada (PHAC, 2011), routine medical examine determinants include social support networks, social environments, physical environments, income and social status, employment and working conditions, education and literacy, personal health practices and coping skills, healthy child development, biology and genetic endowment, health services, culture, and gender. Each of these determinants impacts health and is interconnected with the other social determinants.

Communities in Uganda seek help from physicians irrespective of problem severity, schedule fewer routine annual health examinations. More routine health surveillance might counterbalance the markedly earlier onset of and greater morbidity and premature mortality from preventable conditions (eg, cardiovascular disease, stroke, hypertension, and heart failure) experienced by these communities. Thus, the study seeks to assess the determinants of routine medical examination among the community in Ntaawo ward Mukono municipality.

1.2 Problem Statement

There has been an increasing burden of mortality and morbidity of people in Uganda due to preventable diseases like cancer, diabetes, hypertension, ulcers which can be detected earlier through routine medical examination.

In Mukono Church of Uganda hospital, 1261 people came for health services in the month of January 2017,1113 came for other conditions and only 148 patients came for routine medical examinations (20 were diagnosed with hypertension, 9 – diabetes, 1 – renal disease, 60 – malaria, 58 came for voluntary counseling and testing of HIV and only 3 were diagnosed HIV positive). This shows that few people come for routine medical examination and Ntaawo being a village in Mukono contributes to this great problem. Thus, the researcher interested in assessing the determinants of routine medical examination among the community.

1.3 Purpose of the study

To assess the determinants of routine medical examination among the community of Ntaawo ward, Mukono municipality.

1.4 Specific objectives

1. To assess the personal determinants that influence access to routine medical examination among the community of Ntaawo ward, Mukono municipality.
2. To identify the socio-economic determinants that influence access to routine medical examination among the community of Ntaawo ward, Mukono municipality.

• To assess the health facility related determinants that influence access to routine medical examination among the community of Ntaawo ward, Mukono municipality.

1.5 Research questions

1. What personal determinants influence access to routine medical examination among the community of Ntaawo ward, Mukono municipality?
2. What socio-economic determinants influence access to routine medical examination among the community of Ntaawo ward, Mukono municipality?

• What health facility related determinants influence access to routine medical examination among the community of Ntaawo ward, Mukono municipality?

1.6 Justification for the study

To the community of Ntaawo, the study will help them acquire information on determinants of routine medical examination which help them to have knowledge of the importance of routine medical examination. This will be done by holding a session with them which will take 30 minutes to discuss the results and recommendation.

To local leaders, the findings will form a basis upon which appropriate interventions can be devised to improve access to routine medical examination for their community members. This will be ensured by the researcher giving a report copy to the local leaders.

To health workers, the study will enable them realise the health related determinants that influence people’s access to routine medical examination and hence improve areas which need to be improved.

To other researchers, the research report will act as a source of literature to other future researchers. This will be ensured by putting a copy of the report in the school library.

To the researcher, the research findings will help attain a diploma in midwifery of UNMEB since it’s a requirement. This will be done by disseminating a report book to UNMEB

CHAPTER TWO

LITERATURE REVIEW

2.1 Introduction

This chapter presents literature related to determinants that other researchers have reviewed which is in line with personal determinants, socio economic determinants and health facility related determinants influencing access to routine medical examinations.

2.2 Personal determinants that influence routine medical examination

According to Winklebly (2014), education shapes future occupational opportunities and earning potential. It also provides knowledge and life skills that allow better-educated persons to gain more ready access to information and resources to promote health services such as medical examination.

According to Mare (2012) in his study Socio-Economic Careers and Measurement and Analysis of Mortality, he stated that the work status of women has also been linked to knowledge and use of medical examinations. Women who work outside the home have higher rate of accessing routine medical examination than women who do not work outside home (housewives). Working women, particularly, those who earn cash incomes are assumed to have greater control over household decisions and increased awareness of the world outside home.

Winklebly (2014), also hypothesized that there is a positive correlation between medical examination use and level of education. Other things being equal the higher the level of education the higher medical examination use is expected to be.

The observed variation in medical examination use by place of residence may be attributed to differences in the availability of such social services as education, information about medical examination, access to medical examination and health care services (Lantz, 2008).

Increasing knowledge and awareness of the determinants influencing access to health care services and how they interact can inform effective policy development and improve the availability and accessibility of health care services that fit the needs of different communities. Therefore, increased awareness and knowledge about health issues influences the access to routine medical examination.

2.3 Socio-economic determinants that influence routine medical examination

UDHS (2011) showed that Ugandan women in the lowest wealth quintile have no access to routine medical examination as those in the highest wealth quintile. Percentage of women in the lowest quintile has no education compared with 38 percent in the highest quintile” shows the obvious fact that wealth and education go hand-in-hand and, together, make the biggest fertility impact. The lower the income levels the higher the access to routine medical examination.

According to Link and Phelan (2010) the inequalities in the apparent circumstances of individual’s lives, like individuals’ access to health care, schools, their conditions of work and leisure, households, communities, towns, or cities,  affect people’s ability to lead a flourishing life and maintain health, thus access to routine medical examination.

Household financial capacity is one of the major factors in the determinants of routine medical examination, and this depends on occupation of family members.

Women who are working and earning money may be able to save and decide to spend it on a health issues. Several studies find that farming women are less likely to have routine examination than women in other occupations (PHAC, 2011). This may be due to limited financial resources and health services in such areas.

2.4 Health facility related determinants that influence routine medical examination

Unreliable transport is also a barrier to access health services, failure to plan in advance for transport cause higher number of people to forego routine medical examination (Mrisho et al, 2007).

In most developing countries, inadequate knowledge and skills for health workers on management of obstetrics cases can be the barrier for routine medical examination in health facilities, several study found that health workers tend to unnecessary refer pregnant mother to higher level because they don’t know to use partogram which monitor the progress of labour and the woman end up deliver normally. This woman will never come back to that facility due to unnecessary referral to other health facility (Shankwaya, 2008)

Lack of privacy is also documented as a barrier for routine medical examination in health facilities because some older women they don’t want to be attended by younger nurses at health facilities who they think there are like their daughter or younger women they like to be attended by male health workers. In other health facilities there is no special room for such activities. This condition hinders to have access to health facilities (Mrisho et al, 2007)

Health provider behavior and attitudes are also determinant factor, some of the health workers are very rude, using abusive language and refusing to assist the patients, and these attitudes limit access to routine medical examination however positives attitudes of health workers attract people in health facilities (Mrisho et al, 2008).

Distance is one of the determinants for routine examination especially in rural areas where by health facilities are scarcely distributed. It is relevant to have health facility which is well equipped and properly staffed but not accessed by anyone due to walking distance. Shankwaya (2008) noted that the use of health services decline with distance.

CHAPTER THREE

METHODOLOGY

3.1 Introduction

The chapter focuses on the methods and procedures that will be used in conducting the study which includes; the study design and rationale, study setting and rationale, study population, sample size determination, sampling procedure, inclusion criteria, exclusion criteria, definition of variables, research instruments, data collection procedure, data management, data analysis, ethical consideration, anticipated limitation of the study and dissemination of results.

3.2 Study Design and rationale

The study will be cross sectional and descriptive in design, employing quantitative data collection method. It will be a cross sectional type of design because a number of variables like age, gender, religion, and education will be assessed. The study design will be chosen because it will help to study various determinants i.e. personal, social-economic and health related determinants affecting access to routine medical examination.

3.3 Study setting and rationale

The study will be conducted in Ntaawo ward Mukono municipality. Mukono Municipality is bordered by Kayuga to the north, Wakiso district to the west, Lake Victoria to the south and Buikwe to the east. On 27 August 2014, the national population census put Mukono’s population at 161,996 (UBOS, 2014). The main economic activities that people engage in include farming and businesses. The stable food is matooke and potatoes. This area is chosen because it is near for the researcher to access.

3.4 Study Population

The study will target men and women who live in Ntaawo and are above 18years.

3.4.1 Sample Size Determination

The study will involve 30 respondents. The research will choose only 30 respondents because they are representative enough of the study population and because of the limited finances and time.

3.4.2 Sampling procedure

Purposive sampling will be employed where respondents will be sampled from their homes until the required sample size is obtained.

3.4.3 Inclusion criteria

The study will include men and women who are 18years and above living in Ntaawo village.

3.4.4 Exclusion Criteria

The study will exclude men and women below 18years and are not living in Ntaawo village.

3.5 Definition of variables

Variables are the characteristics of a respondent the researcher wishes to explore or study.

Independent variables

These are the demographic characteristics of the respondents such as age, marital status, education, occupation.

Dependent variable

The dependent variables of the study will be personal determinants and socio-economic variable.

Personal determinants: are the individual determinants that strongly influence their behaviors.

Social Economic determinants: this refers to how economic activity affects and is shaped by social processes. In general it analyzes how societies progress, stagnate, or regress because of their local or regional economy, or the global economy.

Health facility related determinants: are determinants that affect individuals within the health facility.

3.6Research Instruments

A questionnaire will be used which will be first pretested on 5 people in Kauga village to assess its effectiveness and accuracy. The questionnaire will be written in English. The questionnaire will also be interpreted in Luganda for the illiterate respondents.

3.7 Data Collection Procedure

A letter of introduction will be obtained from Public Health Nurses’ College which will be given to the LC 1 chairperson who will be explained to the purpose and objective of the study. The LC 1 chairperson will introduce the researcher to the village health team (VHT) member who will help to introduce the researcher to the respondents. The researcher will explain the purpose and objective of the study to respondents and ask for their informed consent. Every respondent who will fit in the inclusion criteria and is willing to consent will be given a questionnaire to answer and for those who don’t understand English and will be assisted by the research assistant. Every completed questionnaire will be collected per day until the desired number of respondents is reached. The researcher will sample 6 respondents per day for a period of 5 days to make a total of 30 respondents.

3.7.1 Data management

This will include all measures put in place to ensure that quality data is obtained. The management will include data editing before leaving the area of study to ensure that there are no mistakes or areas left blank and if any mistakes are found they will be corrected before leaving the field. The researcher will also code the questionnaire and store them in the file for safety and locked in a place which can only be accessed by the researcher.

3.7.2 Data analysis and presentation

The data will be analysed manually by use of pens and papers to tally thereafter quantitative data will be analyzed statistically and presented in tables, figure and narratives.

3.8 Ethical Consideration

A letter of introduction will be obtained from Kyambogo Public Health Nurses College seeking permission to carry out the study. The letter will be presented to the local council one chairperson who will introduce the researcher to the village health team (VHT)member who will help to introduce the researcher to the respondents.  The study will only commence after the purpose and the objectives of the study have been clearly and well explained to participants. Only those who will be willing to participate in the study will be given questionnaire. Respondents will be assured of confidentiality and privacy.

3.9 Anticipated Limitations of the Study

The researcher might face a challenge of limited cooperation from the respondents. This may be due to their own reasons among themselves being that they have limited time and interest in providing the information required. However, the researcher will strive to explain to them the importance of the study as academic so as to get their cooperation.

Also the researcher may face a challenge of some respondents who are not literate. This will be overcome by translating to them the meaning of the questions in the language that they understand.

The research may face limited time to carry out research and other classroom work. However, the researcher will draw a work plan which will be strictly followed.

The Researcher may be limited by financial resources such as the transport costs and stationery to carry out her research effectively. In an effort to mitigate this shortcoming, the researcher will source for funds from a few relatives.

3.10 Dissemination of results

The results will be disseminated to:-

• Uganda Nurses and Midwives Examination Board (UNMEB)
• Public Health Nurses College (PHNC)
• LCI chairperson.
• Community of Ntaawo.

REFERENCES

Dunlop, S., Coyte, P. & McIsaac, W. (2010). “Socio-Economic Status and the Utilization of Physicians’ Services: Results from the Canadian National Population Health Survey,” Social Science and Medicine.

Hertzman, C. (2009). “Population Health and Human Development,” in Developmental Health and the Wealth of Nations, ed. (New York: Guilford Press).

Kaplan, G. (2007). Utilization of Health Care Services by Pregnant Mothers during Delivery. Hills

Kaplan, G.A. (2007). “Inequality in Income and Mortality in the United States: Analysis of Mortality and Potential Pathways,” British Medical Journal.

Lantz, P.M. (2008). “Socioeconomic Determinants, Health Behaviors, and Mortality: Results from a Nationally Representative Prospective Study of U.S. Adults,” Journal of the American Medical Association 279.

Link, B.G. and Phelan, J. (2010). “Social Conditions as Fundamental Causes of Disease,” Journal of Health and Social Behavior.

Link, N. & Phelan, R.Y. (2010). Determinants of utilization of health services by pregnant women in Rwanda.

Mare, R.D. (2012). “Socio-Economic Careers and Differential Mortality among Older Men in the U.S.,” in Measurement and Analysis of Mortality. Oxford: Clarendon.

McGinnis, H. & Foege, J. (2011); Determinants of routine medical examination in Germany. Pretor.

McGinnis, J.M. and Foege, W.H. (2011). “Actual Causes of Death in the United States,” Journal of the American Medical Association. Independent Inquiry into Inequalities in Health: Report, London: Stationery Office.

Pamuk, E. (2009). Socio-economic Status and Health Chartbook: Health, United States, (Hyattsville, Md.: National Center for Health Statistics.

Pamuk, J.G (2009), Low use of health services; Impact of women status, traditional beliefs and limited resources.

Pappas, G. (2013). “The Increasing Disparity in Mortality between Socioeconomic Groups in the United States,” New England, Journal of Medicine 329.

Pappas, S.S. (2013). Study to explore barriers to utilization of Medical examination in Kazungula district in Zambia.

Ross, C.E. and Mirovsky, J. (2011). “Does Unemployment Affect Health?” Journal of Health and Social Behavior.

Wilkinson, R.G. (2010). Unhealthy Societies: The Afflictions of Inequality (London: Routledge)

Winkleby, M.A. (2014). “Socioeconomic Status and Health: How Education, Income, and Occupation Contribute to Risk Determinants for Cardiovascular Disease,” American Journal of Public Health.

APPENDICES

APPENDIX I

CONSENT FORM

PARTICIPANTS

Researcher: Namyalo Agnes

Topic: Determinants of routine medical examination among the community of Ntaawo ward, Mukono Municipality

The purpose of this study is to assess determinants of routine medical examination among the community and the objectives of the study are to assess the personal determinants, socio economic determinants and health facility related determinants influencing access to routine medical examination.

The information you give will be treated with maximum confidentiality and you are assured of privacy.

No names will be included in this research but only numbers. This research is for academic purposes only and no financial benefits will be given.

This research will take you 20 – 30 minutes to complete.

I Namyalo Agnes have clearly explained the purpose and objectives of the study to the respondents and he/she has understood and consented to participate.

Signature: …………………………………… Date: …………………………………

(Researcher)

I have clearly understood the purpose and objectives of the study and voluntarily accept to participate in the study.

Signature: …………………………………… Date: …………………………………

(Respondent)

APPENDIX II

BUDGET

APPENDIX III

WORK PLAN

APPENDIX IV

QUESTIONNAIRES

TOPIC: DETERMINANTS OF ROUTINE MEDICAL EXAMINATION AMONG THE COMMUNITY OF NTAAWO WARD, MUKONO MUNICIPALITY

Respondent NO.: …………………………

INSTRUCTIONS

1. Answer all questions in this questionnaire
2. Don’t include your name.

• Tick the correct answer in the box provided.

SECTION A: SOCIO-DEMOGRAPHIC CHARACTERISTICS OF RESPONDENTS

1. What is your age?
2. 18 – 19
3. 20 – 22
4. 23– 25
5. 25 and above
6. What is your tribe?
7. Muganda
8. Musoga
9. Mukiga
10. Munyankore
11. Other (Specify)………………………………………………..
12. What is your religion?
13. Catholic
14. Protestant
15. Muslim
16. Pentecostal
17. Seventh Day Adventist
18. Others (specify)………………………………………………….
19. What is your marital status?
20. Single
21. Married
22. Divorced
23. Widowed
24. Other (specify)…………………………………………………

5. What is your level of education?
6. Uneducated
7. Primary
8. Secondary
9. Tertiary/University

6. What is your main occupation?
7. Farmer
8. Business
9. Civil servant
10. House wife
11. Other (specify)………………………………………………..

SECTION B: PERSONAL DETERMINANTS

7. Have you ever heard about routine medical examination?
8. No
9. Yes
10. If yes, where did you hear it from?

………………………………………………………………………….

9. What is routine medical examination?
10. Is the process by which a medical professional investigates the body of a patient for signs of disease.
11. Is the process by which a medical professional investigates the body of a patient for signs of disease on a routine basis.
12. Others specify……………………………………………………………………
13. Have you ever gone for routine medication examination?
14. No
15. Yes
16. If yes, when?

………………………………………………………………………………………..

12. What is your attitude towards routine medical examination?
13. Positive
14. Negative
15. If positive, how often do you access routine medical examination?
16. Often
17. Not often
18. Not at all
19. If not at all, what leads to that?
20. distance of location
21. culture
22. education level
23. Attitude
24. Others specify……………………………………………………………………

SECTION C: SOCIO ECONOMIC DETERMINANTS

15. Do you have a peer group?
16. Yes
17. No
18. If yes from above, what issues do you discuss with your peer group concerning medical checkup?

………………………………………………………………………………………..

………………………………………………………………………………………..

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17. Do you think your job affects your access to routine medical examination?
18. Yes
19. No
20. If yes how?

………………………………………………………………………………………..

………………………………………………………………………………………..

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19. Do you think that income affects ones access to routine medical examination?
20. Yes
21. No
22. If yes, how?

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21. If no, why?

………………………………………………………………………………………..

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22. Do educated people have access to routine medical examination than uneducated ones?
23. Yes
24. No
25. If yes, why?

………………………………………………………………………………………..

………………………………………………………………………………………..

………………………………………………………………………………………..

24. Do you easily have access to routine medical examination?
25. Yes
26. No
27. If no, why?

………………………………………………………………………………………..

………………………………………………………………………………………..

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SECTION D: HEALH FACILITY RELATED DETERMINANTS

26. Are the medical workers available?
27. Yes
28. No
29. If no, what do you do?

………………………………………………………………………………………..

………………………………………………………………………………………..

28. Is the health facility equipped to carryout routine medical examination?
29. Yes
30. No
31. If no, how do you deal with it?

………………………………………………………………………………………..

………………………………………………………………………………………..

………………………………………………………………………………………..

30. Does the distance between the health facility and the community affect accessibility to routine medical examination?
31. Yes
32. No
33. If yes, why?

………………………………………………………………………………………..

………………………………………………………………………………………..

………………………………………………………………………………………..

32. If no, why?

………………………………………………………………………………………..

………………………………………………………………………………………..

………………………………………………………………………………………..

33. What attitude do you have towards the health workers?
34. Positive
35. Negative
36. If negative, how does it affect your accessibility to routine medical examination?

………………………………………………………………………………………..

………………………………………………………………………………………..

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THANK YOU FOR YOUR TIME