Health seeking

Using data from Wave 1 (2004)(2005)(2006) of the National Survey of Fertility Barriers (NSFB), a national probability sample of women ages 25-45, we examine online information-seeking among ever-infertile women. Of the 1352 women who met criteria for infertility, 459 (34%) neither talked to a doctor nor went online for information, 9% went online only for information, 32% talked to a doctor but did not go online, and 25% did both. Guided by Chrisman's Health-Seeking Model and previous research on Internet use to obtain health information, we employ multinomial logistic regression to compare these four groups of ever-infertile women. Findings generally support Chrisman's model. Infertile women tend to seek information online as a complement to, rather than as a substitute for, in-person health-seeking. Greater faith in the ability of medical science to treat infertility and greater perceived stigma were associated with higher odds of using the Internet to obtain information about infertility. In general, women who perceived the symptoms of infertility as more salient had higher odds of using both online and in-person or only in-person health-seeking compared to online health-seeking. Women with greater resources had higher odds of using online sources of information. Strong network encouragement to seek treatment was associated with higher odds of in-person health-seeking and combining in-person and online health-seeking compared to only going online or doing nothing.

Background: Depression is one of the mental health issues that has a significant worldwide impact. Findings: Majority of the cases of depression are either underdiagnosed or misdiagnosed as most of the time the symptoms are masked by cognitive decline due to ageing. The study was conducted to estimate the prevalence of depression among the elderly and to identify the sociodemographic and health-related factors associated with geriatric depression. Methodology: Using the Simple Random Sampling technique, 2000 elderly individuals participated in this cross-sectional analytical study. Depression was evaluated using the Geriatric Depression Scale (GDS 15). The enter method was used to do a multivariate binomial logistic regression analysis. Results: According to GDS-15, depression affected 40.1% of the elderly population. Age (61-80) years, financial dependence on family and presence of chronic comorbidity were the variables in multivariate binomial logistic regression analysis that were significantly linked to geriatric depression. About 42.5% visit the health facility only when sick and majority 60.6% preferred government health facility. Conclusion: Reducing the growing prevalence of late-life mental health problems in aging populations requires improving economic stability, addressing social causes, and encouraging regular screening for depression in older persons.

This study aims to discover the triggering events leading to the migration and social problems of returnee ‘Kayayei’ in Zebilla, Ghana. The
study used a qualitative research methodology and a constructivist research paradigm. All of the female returnees "Kayayei" in Zebilla, make
up the research population. Eleven young women, known as "Kayayei," who had returned from places like Kumasi and Accra comprised the
study's sample. Snowball and purposeful methods of sampling were employed to choose study participants. The instrument used for the
study was a semi-structured interview. The qualitative data collected from the interview were recorded, translated, and transcribed verbatim,
and names that were not their real names were assigned. Data was analysed thematically. The study revealed that triggering events leading to
the migration of Kayayei from Zebilla were a lack of job opportunities, outmoded cultural practices, peer group pressure, family pressure,
and conflict. The study further revealed that the social challenges faced by returnee Kayayei were outmoded cultural practices, poverty, and
black magic/juju. The study recommended that Bawku West District Assembly should enact bye-laws to modify some aspects of their
outmoded cultural practices, such as early/forced marriages within the district. This will go a long way in helping the returnee “Kayayei” to
reintegrate successfully. Additionally, as part of its programme to reduce poverty, the government should designate a specific area for the
creation of jobs in the northern region of the nation, where these young women migrate from. This programme should concentrate on
improving the viability and sustainability of the shea nut factory, giving these young women the opportunity to find employment there

Sudan between 2009 and 2012. It was aimed at determining the challenges which vulnerable groups, such as persons with disabilities, experience when accessing health care. It also aimed at identifying non-users of health services at the community level and reasons why they were not accessing these services. The study found that members of the Zion Church do not seek treatment from public or private health facilities, or from traditional healers. Not much has been written about how members of the Zion Church in Malawi seek health care. This paper explores how members of the Zion Church seek health care during illness episodes. The study was conducted in four districts in Malawi. A total of twenty-five members and non-members of this church were interviewed to determine how they sought health care. The study found that members of the Zion Church do not use Western medicine: the church does not allow them to seek treatment either from Western health facilities or traditional healers, otherwise they risk excommunication. Senior members of the church pray for the sick, and patients also seek treatment from the Zion Church clinic, where prayers, blessed water, and amulets are used in the treatment of diseases. Non-members who seek treatment from the Zion Church Clinic are advised to first seek treatment from traditional healers and health facilities. The Zion Church clinic should be the last resort for these * The data collection for this study was made possible with financial support from the European Union.

Studies have shown that rural-urban migrants migrate to search for employment opportunities in urban areas. Despite the prominence of this factor, little is known of how rural-urban migrants jostle for employment in the cities. Using a case study research design and a qualitative research strategy, this study investigates how rural migrants in Ghana jostle for employment in the urban areas. Specifically, the study investigates the factors that influence migrants' decision to migrate to urban areas, their job search strategies, the challenges they face and their coping strategies. Also, the use of the outcomes of their employment activities on their livelihoods are examined. Data were collected from 89 migrants and 16 opinion leaders in Aboabo, a suburb in Kumasi, Ghana, using interviews, focus group discussions and observations. The study draws from the Social Networks Theory and The Sustainable Livelihood Approach to conduct the study. The results show that the reasons for migration are mostly economic and are linked to unemployment, low incomes, lack of rural job opportunities, climate change and worsening living conditions in the rural areas. Migrants mostly engage in informal activities in the city because of their low levels of formal education. The findings reveal that despite being accused as the cause of increasing unemployment in urban Ghana, migrants jostle for employment by engaging in multiple income generating activities, creating their own jobs in the informal sector, employing each other and depending on friends and relatives and using their mobile phones for job-related information. In the process of engaging in their employment activities, they are vulnerable of being victimised, stigmatised, and criminalised and are challenged with physical injuries, indebtedness, and cheating from their customers. These challenges emanate from their relationship with the native residents, city authorities and law enforcement agencies and the migrant's low level of educational attainment, youthful age structure and the nature of their jobs. The migrants cope with these challenges by seeking the help of friends and relatives and ethnic associations in addition to depending on their spiritual and religious belief systems. The migrants use the outcomes of their employment activities to improve their livelihoods through investing in agriculture, building houses, establishing businesses and educating their children. ii DEDICATION To my mother Mma Amina Mahaha for her love and support throughout my education. To the memory of my late father, Wulana Alhassan Yakubu, may peace and the blessings of Allah be upon your soul. To all those who give up their comfort to help sustain the livelihoods of their families in rural areas. iii ACKNOWLEDGEMENTS My sincere gratitude goes to Allah for the strength, wisdom and ability bestowed on me to successfully finish this exercise peacefully. I also extend my sincere gratitude to the Norwegian Government (Norwegian State Education Loan Fund (Lånekassen) for funding my studies. I also thank the Department of Global Development and Planning and the University of Agder for giving me the opportunity to study my masters. My special appreciation goes to my supervisor Hans Kjetil Lysgård for sparing time out of his busy schedule to supervise this work. I also like to thank all the professors and administrators of the Department for their immense guidance throughout my studies. Sincere gratitude goes to

Background of the study: Snakebite is one of the devastating NTDs, the outcome of its management depends on the health-seeking behavior of the victims. There are many factors that influence healthcare seeking behavior in general, which of these factors that influence the healthseeking behavior of snakebite victims in communities of Kaltungo local government area is not clearly known. Aim: The aim of this study is to assess predisposing factors to snakebite, and the health-seeking behavior of the snakebite victims in kaltungo LGA, Gombe. Methodology: A descriptive cross-sectional study was conducted among 398 participants in a community of Kaltungo local government area. Pre-tested and standardized questionnaires were used to obtain relevant information by trained research assistants. Result: Visits to traditional healers (48%) was most common source of healthcare sought after snakebite. This was followed by visits to hospital (41.7%), spiritual healers (4.8%) and Chemist (5.5%). About a third (33.2%) of the respondents considered treatment effectiveness as the most important factor affecting health-seeking behaviour. This was followed by affordability (20.9%), proximity (11.8%), relative cost of treatment (10.8%) and service availability (6.0%). Educational level (X 2 = 7.584, p=0.05) is significantly associated with seeking healthcare from formal source Conclusion: Appropriate health-seeking behaviour among snakebite victims was found to be high among the educated. Thus, those with lower levels of education need to be targeted during health education program to improve health-seeking behaviour among snakebite victims. In addition, health insurance schemes should be extended to cover more of the population.

Background of the study: Snakebite is one of the devastating NTDs, the outcome of its management depends on the health-seeking behavior of the victims. There are many factors that influence healthcare seeking behavior in general, which of these factors that influence the healthseeking behavior of snakebite victims in communities of Kaltungo local government area is not clearly known. Aim: The aim of this study is to assess predisposing factors to snakebite, and the health-seeking behavior of the snakebite victims in kaltungo LGA, Gombe. Methodology: A descriptive cross-sectional study was conducted among 398 participants in a community of Kaltungo local government area. Pre-tested and standardized questionnaires were used to obtain relevant information by trained research assistants. Result: Visits to traditional healers (48%) was most common source of healthcare sought after snakebite. This was followed by visits to hospital (41.7%), spiritual healers (4.8%) and Chemist (5.5%). About a third (33.2%) of the respondents considered treatment effectiveness as the most important factor affecting health-seeking behaviour. This was followed by affordability (20.9%), proximity (11.8%), relative cost of treatment (10.8%) and service availability (6.0%). Educational level (X 2 = 7.584, p=0.05) is significantly associated with seeking healthcare from formal source Conclusion: Appropriate health-seeking behaviour among snakebite victims was found to be high among the educated. Thus, those with lower levels of education need to be targeted during health education program to improve health-seeking behaviour among snakebite victims. In addition, health insurance schemes should be extended to cover more of the population.

Background: How people respond to febrile illness is critical to malaria prevention, control, and ultimately elimination. This article explores factors affecting treatment-seeking behaviour for febrile illnesses in a remote area of Lao PDR. Methods: Household heads or their representatives (n = 281) were interviewed using a structured questionnaire. A total of twelve focus group discussions (FGDs) each with eight to ten participants were conducted in four villages. In addition, observations were recorded as field notes (n = 130) and were used to collect information on the local context, including the treatment seeking behaviour and the health services. Results: Almost three-quarters (201/281) of respondents reported fever in past two months. Most (92%, 185/201) sought treatment of which 80% (149/185) sought treatment at a health centre. Geographic proximity to a health centre (AOR = 6.5; CI = 1.74-24.25; for those < 3.5 km versus those > 3.6 km) and previous experience of attending a health centre (AOR = 4.7; CI = 1.2-19.1) were strong predictors of visiting a health centre for febrile symptoms. During FGDs, respondents described seeking treatment from traditional healers and at health centre for mild to moderate illnesses. Respondents also explained how if symptoms, including fever, were severe or persisted after receiving treatment elsewhere, they sought assistance at health centres. Access to local health centres/hospitals was often constrained by a lack of transportation and an ability to meet the direct and indirect costs of a visit. In Nong District, a rural area bordering Vietnam, people seek care from health centres offering allopathic medicine and from spiritual healers. Decisions about where and when to attend health care depended on their economic status, mobility (distance to the health centre, road conditions, availability of transport), symptoms severity and illness recognition. Current and future malaria control/elimination programmes could benefit from greater collaboration with the locally accessible sources of treatments, such as health volunteers and traditional healers.

Studies have shown that rural-urban migrants migrate to search for employment opportunities in urban areas. Despite the prominence of this factor, little is known of how rural-urban migrants jostle for employment in the cities. Using a case study research design and a qualitative research strategy, this study investigates how rural migrants in Ghana jostle for employment in the urban areas. Specifically, the study investigates the factors that influence migrants' decision to migrate to urban areas, their job search strategies, the challenges they face and their coping strategies. Also, the use of the outcomes of their employment activities on their livelihoods are examined. Data were collected from 89 migrants and 16 opinion leaders in Aboabo, a suburb in Kumasi, Ghana, using interviews, focus group discussions and observations. The study draws from the Social Networks Theory and The Sustainable Livelihood Approach to conduct the study. The results show that the reasons for migration are mostly economic and are linked to unemployment, low incomes, lack of rural job opportunities, climate change and worsening living conditions in the rural areas. Migrants mostly engage in informal activities in the city because of their low levels of formal education. The findings reveal that despite being accused as the cause of increasing unemployment in urban Ghana, migrants jostle for employment by engaging in multiple income generating activities, creating their own jobs in the informal sector, employing each other and depending on friends and relatives and using their mobile phones for job-related information. In the process of engaging in their employment activities, they are vulnerable of being victimised, stigmatised, and criminalised and are challenged with physical injuries, indebtedness, and cheating from their customers. These challenges emanate from their relationship with the native residents, city authorities and law enforcement agencies and the migrant's low level of educational attainment, youthful age structure and the nature of their jobs. The migrants cope with these challenges by seeking the help of friends and relatives and ethnic associations in addition to depending on their spiritual and religious belief systems. The migrants use the outcomes of their employment activities to improve their livelihoods through investing in agriculture, building houses, establishing businesses and educating their children. ii DEDICATION To my mother Mma Amina Mahaha for her love and support throughout my education. To the memory of my late father, Wulana Alhassan Yakubu, may peace and the blessings of Allah be upon your soul. To all those who give up their comfort to help sustain the livelihoods of their families in rural areas. iii ACKNOWLEDGEMENTS My sincere gratitude goes to Allah for the strength, wisdom and ability bestowed on me to successfully finish this exercise peacefully. I also extend my sincere gratitude to the Norwegian Government (Norwegian State Education Loan Fund (Lånekassen) for funding my studies. I also thank the Department of Global Development and Planning and the University of Agder for giving me the opportunity to study my masters. My special appreciation goes to my supervisor Hans Kjetil Lysgård for sparing time out of his busy schedule to supervise this work. I also like to thank all the professors and administrators of the Department for their immense guidance throughout my studies. Sincere gratitude goes to

Background of the study: Snakebite is one of the devastating NTDs, the outcome of its management depends on the health-seeking behavior of the victims. There are many factors that influence healthcare seeking behavior in general, which of these factors that influence the healthseeking behavior of snakebite victims in communities of Kaltungo local government area is not clearly known. Aim: The aim of this study is to assess predisposing factors to snakebite, and the health-seeking behavior of the snakebite victims in kaltungo LGA, Gombe. Methodology: A descriptive cross-sectional study was conducted among 398 participants in a community of Kaltungo local government area. Pre-tested and standardized questionnaires were used to obtain relevant information by trained research assistants. Result: Visits to traditional healers (48%) was most common source of healthcare sought after snakebite. This was followed by visits to hospital (41.7%), spiritual healers (4.8%) and Chemist (5.5%). About a third (33.2%) of the respondents considered treatment effectiveness as the most important factor affecting health-seeking behaviour. This was followed by affordability (20.9%), proximity (11.8%), relative cost of treatment (10.8%) and service availability (6.0%). Educational level (X 2 = 7.584, p=0.05) is significantly associated with seeking healthcare from formal source Conclusion: Appropriate health-seeking behaviour among snakebite victims was found to be high among the educated. Thus, those with lower levels of education need to be targeted during health education program to improve health-seeking behaviour among snakebite victims. In addition, health insurance schemes should be extended to cover more of the population.

Child Head Porterage ("Kayaye") is a growing concern to stakeholders in education and this has necessitated the need to study its impact on girls' education in the Tamale Metropolis. The study was guided by four objectives namely; to identify the kind of girl child engaged in head porterage, to find out the reasons or causes of girl child head in porterage, to explore the effects of head porterage on the education of girl child porters and to determine ways by which girl child porterage could be addressed in the study area. The study employed both quantitative and qualitative research strategies or approaches where questionnaires were administered to 120 head porters of basic school-going age and interviews with key stakeholders in the study area. The study found that the majority of girls engaged in head porterage were between 11-14 years. Most of them came from the Northern and the Upper East Regions. The study also revealed that household sizes, occupations of parents and conditions of public basic schools significantly influenced girls engagement in head porterage. The study further found that the head porters were punctual and regular in school and the phenomenon had insignificant impact on school attendance but academic performances of the girls involved. The study found that job creation and good parenting could be effective in addressing the phenomenon in the Tamale Metropolis. Government of Ghana needs to address the challenges of the fCUBE programme in the Tamale Metropolis to ease the financial burden of parents. Increase in job opportunities in the Metropolis would improve the financial conditions of parents, thereby reducing the reliance on girl child to supplement family income. www.udsspace.uds.edu.gh iii DEDICATION To my children, Kasi, Wunnam, Saha and Dawuni www.udsspace.uds.edu.gh iv ACKNOWLEDGEMENT I am profoundly grateful to Dr Sulemana Adams Achanso, my supervisor, whose unyielding desire for excellence and invaluable commentary are the outcome of the work. I must add, however that all errors and inaccuracies that might be found in the work are entirely mine. The work would not have been successful without the cooperation of several organisations in the Tamale Metropolitan area that provided me with a wealth of information. I am accordingly grateful to School for Life, Regional Advisory Information and Network System (RAINS), Northern Sector Action on Awareness Creation (NORSAAC), the Department of Social Welfare, Community Development and the Tamale Metropolitan directorate of the Ghana Education Service. I also owe thanks to the many kayayes operating in the Tamale metropolitan area who despite the drudgery of the trade they ply accepted to be interviewed and offered honest answers to me during the data collection stages of this work. I also appreciate the support of Ms Fareedat Mohammed and her colleagues at University for the Development Studies who worked as field volunteers and administered the questionnaire during the data collection stages of this work. Finally, I will express my gratitude to my family for their patience and understanding all throughout my study at the University for Development Studies. I am particularly thankful to Mr Abdul-Baki Abdulai, my husband who has patiently read the proof of this work and made important corrections and suggestions.

"Background: According to Census 2011 nearly 104 million elderly persons in India.6 The 2011 census reveals that Karnataka has 7.9% elderly population. Health seeking behaviours are influenced by a variety of factors among elderly like socio-economic conditions, age, social status of the person, gender, authority of the elderly within the family.
The objective of the study was to assess the health seeking behaviour among elderly in rural and urban field practice areas of Shimoga institute of medical sciences, shimoga
Methods: A community-based cross-sectional study was conducted in the urban and rural areas of Shimoga district; the study period was from August 2017 to January 2018. Provisional diagnosis of dis-eases of elderly was made based on reported symptoms, clinical evaluation by investigators. The data was collected through predesigned and pretested personal interviews by house-to-house visits after taking informed consent from the participants. The data collected were com-piled and entered into Microsoft Excel software. For statistical analysis, SPSS version 21 was used.
Results: Health seeking behaviors are influenced by a variety of factors among elderly like socioeconomic conditions, age, social status of the person, gender, authority of the elderly within the family. Type of health facility preferred by elderly was government hospital (94.3%) in rural and private hospitals in urban (58.1%)
Conclusion: Health and treatment seeking behaviour among elderly is very poor, which needs a awareness creation and creating easy accessibility of health services. It needs implementation of programs at grass root level."

Nepalese agropastoralists' confrontations with forces of change in the last generation have altered villagers' abilities to gain access to health services, clean water, and nutrition in Humla District, Nepal. Development efforts and Nepal's recent armed conflict, in particular, introduced novel technologies and ideologies that a subsection of villagers have responded to in a fashion that we did not expect. In this article, based on theories about the diffusion of innovation and risk, we argue that, together, villagers and other change agents have cocreated new contexts of vulnerability in the postconflict setting of rural Nepal, as observed in remote Humla District. Using ArcGIS to represent landscapes of health and health-seeking behavior, we explore the integration of neoliberal health development in this postconflict setting in which medical pluralism, caste, Hinduism, and cultural conservatism all shape decision making. Based on in-depth and long-term research conducted in the region over the past 15 years, we describe the strengths and weaknesses of GIS as a tool for enhancing our understanding of this "health landscape." In Humla, topography is a major determinant of access to healthcare. Our analyses reveal interesting relationships among health, culture, and vulnerability and provide insight into directions for future health interventions in similar contexts elsewhere.

Nepalese agropastoralists' confrontations with forces of change in the last generation have altered villagers' abilities to gain access to health services, clean water, and nutrition in Humla District, Nepal. Development efforts and Nepal's recent armed conflict, in particular, introduced novel technologies and ideologies that a subsection of villagers have responded to in a fashion that we did not expect. In this article, based on theories about the diffusion of innovation and risk, we argue that, together, villagers and other change agents have cocreated new contexts of vulnerability in the postconflict setting of rural Nepal, as observed in remote Humla District. Using ArcGIS to represent landscapes of health and health-seeking behavior, we explore the integration of neoliberal health development in this postconflict setting in which medical pluralism, caste, Hinduism, and cultural conservatism all shape decision making. Based on in-depth and long-term research conducted in the region over the past 15 years, we describe the strengths and weaknesses of GIS as a tool for enhancing our understanding of this "health landscape." In Humla, topography is a major determinant of access to healthcare. Our analyses reveal interesting relationships among health, culture, and vulnerability and provide insight into directions for future health interventions in similar contexts elsewhere.

Sudan between 2009 and 2012. It was aimed at determining the challenges which vulnerable groups, such as persons with disabilities, experience when accessing health care. It also aimed at identifying non-users of health services at the community level and reasons why they were not accessing these services. The study found that members of the Zion Church do not seek treatment from public or private health facilities, or from traditional healers. Not much has been written about how members of the Zion Church in Malawi seek health care. This paper explores how members of the Zion Church seek health care during illness episodes. The study was conducted in four districts in Malawi. A total of twenty-five members and non-members of this church were interviewed to determine how they sought health care. The study found that members of the Zion Church do not use Western medicine: the church does not allow them to seek treatment either from Western health facilities or traditional healers, otherwise they risk excommunication. Senior members of the church pray for the sick, and patients also seek treatment from the Zion Church clinic, where prayers, blessed water, and amulets are used in the treatment of diseases. Non-members who seek treatment from the Zion Church Clinic are advised to first seek treatment from traditional healers and health facilities. The Zion Church clinic should be the last resort for these * The data collection for this study was made possible with financial support from the European Union.

This study sought to find out the lifestyle of female single mothers head porters and their coping strategies at Aboabo, in the Kumasi Metropolis. The study aimed to find out the causes of migration, the health, social and institutional challenges that face these vulnerable female single mothers as they seek to meet their daily needs. The research design used for this study was quantitative survey strategy and explanatory. Purposive sampling (judgement/selective/subjective) was used to select the study sample size of one hundred (110) respondents. The data collection instruments were questionnaires. The study findings revealed that: the rainfall pattern in the Northern part of Ghana was unstable and makes most single mothers to migrate to Kumasi to work as head porters. Moreover, some of the health problems face by the head porters included; malaria, typhoid, and anaemia and other diseases due to poor shelter and sanitation. The plight of these vulnerable women would be improved if nongovernmental organizations were invited, encouraged and supported them by providing affordable dormitory accommodation for them and alternative jobs.

This study examined the prevalence and pattern of health-seeking behavior of older people on malaria fever among the elderly in Nigeria. Data from the Nigeria Malaria Indicator Survey were used with a weighted sample of 1819 older persons aged 60 and above across the six geopolitical regions in Nigeria. The odds of fever as well as treatment seeking were predicted using logistic regression models. The prevalence rate of fever among the aged in Nigeria is 28%. About half of the respondents did not receive treatment in a standard health facility. There is high patronage of chemist/patient medicine vendor/shops for malaria fever treatment among older people in Nigeria. Findings suggest that older people may use healthcare facility if it is affordable. The lifelong approach that can reduce poverty and illiteracy is recommended since the ruralurban differences in treatment seeking reduced with the inclusion of other socio-demographic variables in the model.

Nepalese agropastoralists' confrontations with forces of change in the last generation have altered villagers' abilities to gain access to health services, clean water, and nutrition in Humla District, Nepal. Development efforts and Nepal's recent armed conflict, in particular, introduced novel technologies and ideologies that a subsection of villagers have responded to in a fashion that we did not expect. In this article, based on theories about the diffusion of innovation and risk, we argue that, together, villagers and other change agents have cocreated new contexts of vulnerability in the postconflict setting of rural Nepal, as observed in remote Humla District. Using ArcGIS to represent landscapes of health and health-seeking behavior, we explore the integration of neoliberal health development in this postconflict setting in which medical pluralism, caste, Hinduism, and cultural conservatism all shape decision making. Based on in-depth and long-term research conducted in the region over the past 15 years, we describe the strengths and weaknesses of GIS as a tool for enhancing our understanding of this "health landscape." In Humla, topography is a major determinant of access to healthcare. Our analyses reveal interesting relationships among health, culture, and vulnerability and provide insight into directions for future health interventions in similar contexts elsewhere.

Child undernutrition affects millions of children globally, but little is known about the ability of adults to detect different types of child undernutrition in low-income countries. We used focused ethnographic methods to understand how Malawian parents and grandparents describe the characteristics they use to identify good and poor child growth, their actual or preferred patterns of health seeking for undernourished children, and the perceived importance of child undernutrition symptoms in relation to other childhood illnesses. Malawians value adiposity rather than stature in assessing child growth. Symptoms of malnutrition, including wasting and edema, were considered the least severe childhood illness symptoms. Parents delayed health care seeking when a child was ill. When they sought care, it was for symptoms such as diarrhea or fever, and they did not recognize malnutrition as the underlying cause. These findings can be used to tailor strategies for preventing and treating growth faltering in Malawian children.

Background of the study: Snakebite is one of the devastating NTDs, the outcome of its management depends on the health-seeking behavior of the victims. There are many factors that influence healthcare seeking behavior in general, which of these factors that influence the healthseeking behavior of snakebite victims in communities of Kaltungo local government area is not clearly known. Aim: The aim of this study is to assess predisposing factors to snakebite, and the health-seeking behavior of the snakebite victims in kaltungo LGA, Gombe. Methodology: A descriptive cross-sectional study was conducted among 398 participants in a community of Kaltungo local government area. Pre-tested and standardized questionnaires were used to obtain relevant information by trained research assistants. Result: Visits to traditional healers (48%) was most common source of healthcare sought after snakebite. This was followed by visits to hospital (41.7%), spiritual healers (4.8%) and Chemist (5.5%). About a third (33.2%) of the respondents considered treatment effectiveness as the most important factor affecting health-seeking behaviour. This was followed by affordability (20.9%), proximity (11.8%), relative cost of treatment (10.8%) and service availability (6.0%). Educational level (X 2 = 7.584, p=0.05) is significantly associated with seeking healthcare from formal source Conclusion: Appropriate health-seeking behaviour among snakebite victims was found to be high among the educated. Thus, those with lower levels of education need to be targeted during health education program to improve health-seeking behaviour among snakebite victims. In addition, health insurance schemes should be extended to cover more of the population.

Studies have shown that rural-urban migrants migrate to search for employment opportunities in urban areas. Despite the prominence of this factor, little is known of how rural-urban migrants jostle for employment in the cities. Using a case study research design and a qualitative research strategy, this study investigates how rural migrants in Ghana jostle for employment in the urban areas. Specifically, the study investigates the factors that influence migrants' decision to migrate to urban areas, their job search strategies, the challenges they face and their coping strategies. Also, the use of the outcomes of their employment activities on their livelihoods are examined. Data were collected from 89 migrants and 16 opinion leaders in Aboabo, a suburb in Kumasi, Ghana, using interviews, focus group discussions and observations. The study draws from the Social Networks Theory and The Sustainable Livelihood Approach to conduct the study. The results show that the reasons for migration are mostly economic and are linked to unemployment, low incomes, lack of rural job opportunities, climate change and worsening living conditions in the rural areas. Migrants mostly engage in informal activities in the city because of their low levels of formal education. The findings reveal that despite being accused as the cause of increasing unemployment in urban Ghana, migrants jostle for employment by engaging in multiple income generating activities, creating their own jobs in the informal sector, employing each other and depending on friends and relatives and using their mobile phones for job-related information. In the process of engaging in their employment activities, they are vulnerable of being victimised, stigmatised, and criminalised and are challenged with physical injuries, indebtedness, and cheating from their customers. These challenges emanate from their relationship with the native residents, city authorities and law enforcement agencies and the migrant's low level of educational attainment, youthful age structure and the nature of their jobs. The migrants cope with these challenges by seeking the help of friends and relatives and ethnic associations in addition to depending on their spiritual and religious belief systems. The migrants use the outcomes of their employment activities to improve their livelihoods through investing in agriculture, building houses, establishing businesses and educating their children. ii DEDICATION To my mother Mma Amina Mahaha for her love and support throughout my education. To the memory of my late father, Wulana Alhassan Yakubu, may peace and the blessings of Allah be upon your soul. To all those who give up their comfort to help sustain the livelihoods of their families in rural areas. iii ACKNOWLEDGEMENTS My sincere gratitude goes to Allah for the strength, wisdom and ability bestowed on me to successfully finish this exercise peacefully. I also extend my sincere gratitude to the Norwegian Government (Norwegian State Education Loan Fund (Lånekassen) for funding my studies. I also thank the Department of Global Development and Planning and the University of Agder for giving me the opportunity to study my masters. My special appreciation goes to my supervisor Hans Kjetil Lysgård for sparing time out of his busy schedule to supervise this work. I also like to thank all the professors and administrators of the Department for their immense guidance throughout my studies. Sincere gratitude goes to

Non-communicable diseases (NCDs) disproportionately affect people living in fragile contexts marked by poor governance and health systems struggling to deliver quality services for the benefit of all. This combination can lead to the erosion of trust in the health system, affecting health-seeking behaviours and the ability of individuals to sustain their health. In this crosscountry multiple-case study, we analyse the role of trust in health-seeking for NCD services in fragile contexts. Our analysis triangulates multiple data sources, including semi-structured interviews (n = 102) and Group Model Building workshops (n = 8) with individuals affected by NCDs and health providers delivering NCD services. Data were collected in Freetown and Makeni (Sierra Leone), Beirut and Beqaa (Lebanon), and Morazán, Chalatenango and Bajo Lempa (El Salvador) between April 2018 and April 2019. We present a conceptual model depicting key dynamics and feedback loops between contextual factors, institutional, interpersonal and social trust and health-seeking pathways. Our findings signal that firstly, the way health services are delivered and experienced shapes institutional trust in health systems, interpersonal trust in health providers and future health-seeking pathways. Secondly, historical narratives about public institutions and state authorities' responses to contextual fragility drivers impact institutional trust and utilisation of services from public health institutions. Thirdly, social trust mediates health-seeking behaviour through social bonds and links between health systems and individuals affected by NCDs. Given the repeated and sustained utilisation of health services required with these chronic diseases, (re)building and maintaining trust in public health institutions and providers is a crucial task in fragile contexts. This requires interventions at community, district and national levels, with a key focus on promoting links and mutual accountability between health systems and communities affected by NCDs.

Studies have shown that rural-urban migrants migrate to search for employment opportunities in urban areas. Despite the prominence of this factor, little is known of how rural-urban migrants jostle for employment in the cities. Using a case study research design and a qualitative research strategy, this study investigates how rural migrants in Ghana jostle for employment in the urban areas. Specifically, the study investigates the factors that influence migrants' decision to migrate to urban areas, their job search strategies, the challenges they face and their coping strategies. Also, the use of the outcomes of their employment activities on their livelihoods are examined. Data were collected from 89 migrants and 16 opinion leaders in Aboabo, a suburb in Kumasi, Ghana, using interviews, focus group discussions and observations. The study draws from the Social Networks Theory and The Sustainable Livelihood Approach to conduct the study. The results show that the reasons for migration are mostly economic and are linked to unemployment, low incomes, lack of rural job opportunities, climate change and worsening living conditions in the rural areas. Migrants mostly engage in informal activities in the city because of their low levels of formal education. The findings reveal that despite being accused as the cause of increasing unemployment in urban Ghana, migrants jostle for employment by engaging in multiple income generating activities, creating their own jobs in the informal sector, employing each other and depending on friends and relatives and using their mobile phones for job-related information. In the process of engaging in their employment activities, they are vulnerable of being victimised, stigmatised, and criminalised and are challenged with physical injuries, indebtedness, and cheating from their customers. These challenges emanate from their relationship with the native residents, city authorities and law enforcement agencies and the migrant's low level of educational attainment, youthful age structure and the nature of their jobs. The migrants cope with these challenges by seeking the help of friends and relatives and ethnic associations in addition to depending on their spiritual and religious belief systems. The migrants use the outcomes of their employment activities to improve their livelihoods through investing in agriculture, building houses, establishing businesses and educating their children. ii DEDICATION To my mother Mma Amina Mahaha for her love and support throughout my education. To the memory of my late father, Wulana Alhassan Yakubu, may peace and the blessings of Allah be upon your soul. To all those who give up their comfort to help sustain the livelihoods of their families in rural areas. iii ACKNOWLEDGEMENTS My sincere gratitude goes to Allah for the strength, wisdom and ability bestowed on me to successfully finish this exercise peacefully. I also extend my sincere gratitude to the Norwegian Government (Norwegian State Education Loan Fund (Lånekassen) for funding my studies. I also thank the Department of Global Development and Planning and the University of Agder for giving me the opportunity to study my masters. My special appreciation goes to my supervisor Hans Kjetil Lysgård for sparing time out of his busy schedule to supervise this work. I also like to thank all the professors and administrators of the Department for their immense guidance throughout my studies. Sincere gratitude goes to

Studies have shown that rural-urban migrants migrate to search for employment opportunities in urban areas. Despite the prominence of this factor, little is known of how rural-urban migrants jostle for employment in the cities. Using a case study research design and a qualitative research strategy, this study investigates how rural migrants in Ghana jostle for employment in the urban areas. Specifically, the study investigates the factors that influence migrants' decision to migrate to urban areas, their job search strategies, the challenges they face and their coping strategies. Also, the use of the outcomes of their employment activities on their livelihoods are examined. Data were collected from 89 migrants and 16 opinion leaders in Aboabo, a suburb in Kumasi, Ghana, using interviews, focus group discussions and observations. The study draws from the Social Networks Theory and The Sustainable Livelihood Approach to conduct the study. The results show that the reasons for migration are mostly economic and are linked to unemployment, low incomes, lack of rural job opportunities, climate change and worsening living conditions in the rural areas. Migrants mostly engage in informal activities in the city because of their low levels of formal education. The findings reveal that despite being accused as the cause of increasing unemployment in urban Ghana, migrants jostle for employment by engaging in multiple income generating activities, creating their own jobs in the informal sector, employing each other and depending on friends and relatives and using their mobile phones for job-related information. In the process of engaging in their employment activities, they are vulnerable of being victimised, stigmatised, and criminalised and are challenged with physical injuries, indebtedness, and cheating from their customers. These challenges emanate from their relationship with the native residents, city authorities and law enforcement agencies and the migrant's low level of educational attainment, youthful age structure and the nature of their jobs. The migrants cope with these challenges by seeking the help of friends and relatives and ethnic associations in addition to depending on their spiritual and religious belief systems. The migrants use the outcomes of their employment activities to improve their livelihoods through investing in agriculture, building houses, establishing businesses and educating their children. ii DEDICATION To my mother Mma Amina Mahaha for her love and support throughout my education. To the memory of my late father, Wulana Alhassan Yakubu, may peace and the blessings of Allah be upon your soul. To all those who give up their comfort to help sustain the livelihoods of their families in rural areas. iii ACKNOWLEDGEMENTS My sincere gratitude goes to Allah for the strength, wisdom and ability bestowed on me to successfully finish this exercise peacefully. I also extend my sincere gratitude to the Norwegian Government (Norwegian State Education Loan Fund (Lånekassen) for funding my studies. I also thank the Department of Global Development and Planning and the University of Agder for giving me the opportunity to study my masters. My special appreciation goes to my supervisor Hans Kjetil Lysgård for sparing time out of his busy schedule to supervise this work. I also like to thank all the professors and administrators of the Department for their immense guidance throughout my studies. Sincere gratitude goes to

The geographical conditions of an area influence accessibility problems. This study aims to model the travel time to the PONED-Pelayanan Obstetric Neonatal Emergensi Dasar (Basic Emergency Obstetric and Neonatal Care-BEmONC) in a mountain region. The difficulties in access to PONED could cause maternal mortality in mountain regions. This study was done on the island of Adonara in the Flores Timur district. Adonara Island has a high maternal mortality rate. Modelling accessibility used a raster-based model to model travel time. We used Landsat 8 imagery, Digital Elevation Model (DEM), and road network data to obtain a land cover layer. The Saga GIS travel time calculation tool is used to calculate the accumulated cost of travel time. The cost is based on the speed of travel through each land cover pixel to the location of the Puskesmas Waiwerang (PONED 1) and Puskesmas Waiwadan (PONED 2). The results of the travel time modelling show that five sub-districts reach the two PONED locations in ≥ 1 hour. The longest time for people to travel to PONED is ≥ 6 hours from Ile Boleng sub-district because there is a mountain in the Ile Boleng sub-district. The scenario of adding one PONED shows that only two sub-districts reach the PONED in ≥ 1 hour. This scenario shows that adding new PONED can decrease travel time to PONED. The spatial modelling of travel time can be used by local governments in eastern Indonesia to improve access to basic obstetric emergency health centres in mountain areas.

The geographical conditions of an area influence accessibility problems. This study aims to model the travel time to the PONED-Pelayanan Obstetric Neonatal Emergensi Dasar (Basic Emergency Obstetric and Neonatal Care-BEmONC) in a mountain region. The difficulties in access to PONED could cause maternal mortality in mountain regions. This study was done on the island of Adonara in the Flores Timur district. Adonara Island has a high maternal mortality rate. Modelling accessibility used a raster-based model to model travel time. We used Landsat 8 imagery, Digital Elevation Model (DEM), and road network data to obtain a land cover layer. The Saga GIS travel time calculation tool is used to calculate the accumulated cost of travel time. The cost is based on the speed of travel through each land cover pixel to the location of the Puskesmas Waiwerang (PONED 1) and Puskesmas Waiwadan (PONED 2). The results of the travel time modelling show that five sub-districts reach the two PONED locations in ≥ 1 hour. The longest time for people to travel to PONED is ≥ 6 hours from Ile Boleng sub-district because there is a mountain in the Ile Boleng sub-district. The scenario of adding one PONED shows that only two sub-districts reach the PONED in ≥ 1 hour. This scenario shows that adding new PONED can decrease travel time to PONED. The spatial modelling of travel time can be used by local governments in eastern Indonesia to improve access to basic obstetric emergency health centres in mountain areas.

Women in African have being known to be associational migrants; migrating usually as company to family members. In recent years however, a lot of women migrate for their own socioeconomic gains. In Ghana, these women include young and mostly uneducated females from the north of Ghana, who migrate to cities in the south to work as head porters. These women in an attempt to better their economic and social prospects endure the harsh living conditions of the city. They perceive these harsh conditions as a short term pain and sacrifice that must be made for the long term gain of becoming entrepreneurs, buying items for marriage, having enough money to care for family members among others when they eventually return back home. Using the case study approach, this paper explores the after-city-life of these women; in an attempt to determine the extent to which their socioeconomic status is improved; it also assesses the challenges that these women, their families and communities encounter integrating them back into their lives. Results from the study showed that most of these women eventually go back home having achieved their reasons for migrating to the south, they and their communities and families however encounter many challenges upon the return of some of them because of behavioral changes as influenced by of city life and culture.

Background of the study: Snakebite is one of the devastating NTDs, the outcome of its management depends on the health-seeking behavior of the victims. There are many factors that influence healthcare seeking behavior in general, which of these factors that influence the healthseeking behavior of snakebite victims in communities of Kaltungo local government area is not clearly known. Aim: The aim of this study is to assess predisposing factors to snakebite, and the health-seeking behavior of the snakebite victims in kaltungo LGA, Gombe. Methodology: A descriptive cross-sectional study was conducted among 398 participants in a community of Kaltungo local government area. Pre-tested and standardized questionnaires were used to obtain relevant information by trained research assistants. Result: Visits to traditional healers (48%) was most common source of healthcare sought after snakebite. This was followed by visits to hospital (41.7%), spiritual healers (4.8%) and Chemist (5.5%). About a third (33.2%) of the respondents considered treatment effectiveness as the most important factor affecting health-seeking behaviour. This was followed by affordability (20.9%), proximity (11.8%), relative cost of treatment (10.8%) and service availability (6.0%). Educational level (X 2 = 7.584, p=0.05) is significantly associated with seeking healthcare from formal source Conclusion: Appropriate health-seeking behaviour among snakebite victims was found to be high among the educated. Thus, those with lower levels of education need to be targeted during health education program to improve health-seeking behaviour among snakebite victims. In addition, health insurance schemes should be extended to cover more of the population.

Background Sex and gender have been shown to influence health literacy, health seeking behaviour, and health outcomes. However, research examining the links between gender and health has mainly focused on women’s health, which is a long-standing global health priority. We examine literature focused on the ‘missing men’ in global health research, in particular empirical studies that document interventions, programmes, and services targeting men’s health issues in Sub-Saharan Africa. Within these studies, we identify dominant conceptualisations of men and men’s health and how these have influenced the design of men’s health interventions and services. Methods This is a scoping review of published and grey literature. Following comprehensive searches, we included 56 studies in the review. We conducted a bibliographic analysis of all studies and used inductive methods to analyse textual excerpts referring to conceptualizations of men and service design. An existing framework to categori...

Using data from Wave 1 (2004-2006) of the National Survey of Fertility Barriers (NSFB), a national probability sample of women ages 25-45, we examine online information-seeking among ever-infertile women. Of the 1352 women who met criteria for infertility, 459 (34%) neither talked to a doctor nor went online for information, 9% went online only for information, 32% talked to a doctor but did not go online, and 25% did both. Guided by Chrisman's Health-Seeking Model and previous research on Internet use to obtain health information, we employ multinomial logistic regression to compare these four groups of ever-infertile women. Findings generally support Chrisman's model. Infertile women tend to seek information online as a complement to, rather than as a substitute for, in-person health-seeking. Greater faith in the ability of medical science to treat infertility and greater perceived stigma were associated with higher odds of using the Internet to obtain information about infertility. In general, women who perceived the symptoms of infertility as more salient had higher odds of using both online and in-person or only in-person health-seeking compared to online health-seeking. Women with greater resources had higher odds of using online sources of information. Strong network encouragement to seek treatment was associated with higher odds of in-person health-seeking and combining in-person and online health-seeking compared to only going online or doing nothing.

This study examined the prevalence and pattern of health-seeking behavior of older people on malaria fever among the elderly in Nigeria. Data from the Nigeria Malaria Indicator Survey were used with a weighted sample of 1819 older persons aged 60 and above across the six geopolitical regions in Nigeria. The odds of fever as well as treatment seeking were predicted using logistic regression models. The prevalence rate of fever among the aged in Nigeria is 28%. About half of the respondents did not receive treatment in a standard health facility. There is high patronage of chemist/patient medicine vendor/shops for malaria fever treatment among older people in Nigeria. Findings suggest that older people may use healthcare facility if it is affordable. The lifelong approach that can reduce poverty and illiteracy is recommended since the ruralurban differences in treatment seeking reduced with the inclusion of other socio-demographic variables in the model.

Individuals often allow prior investments of time, money or effort to influence their current behavior. A tendency to allow previous investments to impact further investment, referred to as the sunk-cost fallacy, may be related to adverse psychological health. Unfortunately, little is known about the relation between the sunk-cost fallacy and psychological symptoms or help seeking. The current study used a relatively novel approach (i.e., Amazon.com's Mechanical Turk crowdsourcing [AMT] service) to examine various aspects of psychological health in internet users (n = 1053) that did and did not commit the sunk-cost fallacy. In this observational study, individuals logged on to AMT, selected the "decision making survey" amongst the array of currently available tasks, and completed the approximately 200-question survey (which included a two-trial sunk cost task, the brief symptom inventory 18, the Binge Eating Scale, portions of the SF-8 health survey, and other questions about treatment utilization). Individuals that committed the fallacy reported a greater number of symptoms related to Binge Eating Disorder and Depression, being bothered more by emotional problems, yet waited longer to seek assistance when feeling ill. The current findings are discussed in relation to promoting help-seeking behavior amongst individuals that commit this logical fallacy.

Over the past four decades, Accra has witnessed an increasing influx of young women who migrate to the city with the sole aim of carrying goods. This paper examines the migration processes of these young women, who mostly migrate from the northern part of Ghana to Accra, in the South. A sample of 216 female porters were selected for the study. A survey, personal interviews, and focus group discussions were the main tools for data collection. The reasons for their migration, the parties involved in the decision to migrate, and how their migration was financed were explored. The study revealed that the migration process of female porters is enabled by social networks; the women have varying levels of social capital, which facilitates movement and settlement. These social networks increase the social asset base of female porters and provide safety nets for them. It is found that the reasons for their migration are related to the declining importance of agriculture and the non-availabil...

Non-communicable diseases (NCDs) disproportionately affect people living in fragile contexts marked by poor governance and health systems struggling to deliver quality services for the benefit of all. This combination can lead to the erosion of trust in the health system, affecting health-seeking behaviours and the ability of individuals to sustain their health. In this crosscountry multiple-case study, we analyse the role of trust in health-seeking for NCD services in fragile contexts. Our analysis triangulates multiple data sources, including semi-structured interviews (n = 102) and Group Model Building workshops (n = 8) with individuals affected by NCDs and health providers delivering NCD services. Data were collected in Freetown and Makeni (Sierra Leone), Beirut and Beqaa (Lebanon), and Morazán, Chalatenango and Bajo Lempa (El Salvador) between April 2018 and April 2019. We present a conceptual model depicting key dynamics and feedback loops between contextual factors, institutional, interpersonal and social trust and health-seeking pathways. Our findings signal that firstly, the way health services are delivered and experienced shapes institutional trust in health systems, interpersonal trust in health providers and future health-seeking pathways. Secondly, historical narratives about public institutions and state authorities' responses to contextual fragility drivers impact institutional trust and utilisation of services from public health institutions. Thirdly, social trust mediates health-seeking behaviour through social bonds and links between health systems and individuals affected by NCDs. Given the repeated and sustained utilisation of health services required with these chronic diseases, (re)building and maintaining trust in public health institutions and providers is a crucial task in fragile contexts. This requires interventions at community, district and national levels, with a key focus on promoting links and mutual accountability between health systems and communities affected by NCDs.

Health-seeking patterns of persons with tuberculosis (TB) before reporting at the Directly Observed Treatment Short-course (DOTS) clinic for diagnosis and treatment were analysed. A total of 221 persons registered in the DOTS programme in 12 randomly selected rural and urban Local Government Areas in southern Nigeria were interviewed using a semi-structured questionnaire. Perceived causes of TB influenced first choice of treatment. Patients re-evaluated initial choices and shop for alternatives in persistent TB. Chemists were the first port of call for most patients. Those with unscientific causative theories of tuberculosis such as witchcraft engaged more in multiple health-seeking than those who indicated bacterial infection (P< 0.0001). The respondents had a median diagnostic-delay of 90 days. Delay in commencement of DOTS treatment was attributable to ignorance among patients and poor attitude of health workers. In conclusion, delay exists between recognition of symptoms and initiation of treatment in DOTS clinics partly because of ignorance among patients. Health workers' attitude to patients reporting at health clinics also discouraged the use of DOTS facilities. Consequently, it is recommended to address such delay through social mobilization of communities and through engaging Chemists in TB service delivery in this area.

Health-seeking patterns of persons with tuberculosis (TB) before reporting at the Directly Observed Treatment Short-course (DOTS) clinic for diagnosis and treatment were analysed. A total of 221 persons registered in the DOTS programme in 12 randomly selected rural and urban Local Government Areas in southern Nigeria were interviewed using a semi-structured questionnaire. Perceived causes of TB influenced first choice of treatment. Patients re-evaluated initial choices and shop for alternatives in persistent TB. Chemists were the first port of call for most patients. Those with unscientific causative theories of tuberculosis such as witchcraft engaged more in multiple health-seeking than those who indicated bacterial infection (P< 0.0001). The respondents had a median diagnostic-delay of 90 days. Delay in commencement of DOTS treatment was attributable to ignorance among patients and poor attitude of health workers. In conclusion, delay exists between recognition of symptoms and initiation of treatment in DOTS clinics partly because of ignorance among patients. Health workers' attitude to patients reporting at health clinics also discouraged the use of DOTS facilities. Consequently, it is recommended to address such delay through social mobilization of communities and through engaging Chemists in TB service delivery in this area.

Young females usually migrate from the Northern part of Ghana to the South to engage in head porting business. However, the high cost of rent in urban areas and the poor environmental conditions of poor urbanites have exposed head porters to bad conditions with varying implications on health and well-being. This study examines the health-related conditions of female head porters in Kumasi through stakeholders' opinions. The study used quantitative methods in eliciting information from female head-porters in Asokore Mampong, Kumasi. In all, 100 respondents; comprising relatives of female head porters and other opinion leaders such as the Assembly member, Imam, Pastor, Teachers from Northern Ghana, were interviewed through self-administered questionnaires. Data were analyzed using a statistical package for the social sciences (SPSS) and excel. Economic reasons remain topical for the migration of females from the north to the south to engage in head porting. While many of these migrants do not return home, leading to the emergence of migrant settlements in Kumasi, others return to support their families with their earnings. Stakeholders argued that skills development and creating of entrepreneurial ventures are necessary to reduce the northsouth migratory patterns. The migration of females from the north to the south in search of greener pastures is likely to continue as a result of opportunity gaps. However, worsening conditions of living may deteriorate the health conditions of some of the migrants. Stakeholders recommend a new wave of solutions with focus on skills development, job creation, and entrepreneurial training as solutions.