|Year : 2018 | Volume
| Issue : 1 | Page : 31-36
Sociodemographic factors associated with the healthcare-seeking behavior of heads of households in a rural community in Southern Nigeria
Vincent Yakubu Adam1, Adesuwa Queen Aigbokhaode2
1 Department of Community Health, University of Benin Teaching Hospital, Benin City, Nigeria
2 Department of Public Health, Federal Medical Centre, Asaba, Nigeria
|Date of Web Publication||21-May-2018|
Dr. Vincent Yakubu Adam
Department of Community Health, University of Benin Teaching Hospital, PMB 1111, Benin City
Objective: This study identified the factors associated with the healthcare-seeking behavior of heads of households in a rural community in Southern Nigeria. Materials and Methods: A descriptive cross-sectional study was conducted in 2014 among 410 household heads in Ivhiunone, Fugar in Edo State, Nigeria using two-staged sampling technique. Data collection was by means of a structured interviewer-administered questionnaire. IBM SPSS version 20 and PEPI version 4.0 were used for data analysis. Results: Over three-quarters of the respondents, 357 (87.1%) and 346 (84.4%) were males and married. The mean age of respondents was 49.5 ± 15.9 years. The majority of the respondents, 180 (43.9%) and 208 (50.7%) had a secondary level of education and were in the skill level 1 occupational classification. Almost all 406 (98.8%) respondents sought healthcare when ill, and of these, 399 (98.3%) use medications given. The preferred place to seek healthcare when ill by 373 (91.9%) of the respondents was patent medicine stores. Predictors of healthcare-seeking behavior included marital status, level of education and income. Other associated factors were age, sex, and occupational classification. Conclusion: The sociodemographic predictors of healthcare-seeking behavior included marital status, level of education and income. Other associated factors were age, sex, and occupation. Most of the household heads preferred home treatment and sought healthcare in patent medicine stores and hospitals. Improved quality of care provided to clients/patients in healthcare facilities could address the inappropriate healthcare-seeking behavior in the community.
Keywords: Healthcare-seeking behavior, household heads, rural community, Southern Nigeria
|How to cite this article:|
Adam VY, Aigbokhaode AQ. Sociodemographic factors associated with the healthcare-seeking behavior of heads of households in a rural community in Southern Nigeria. Sahel Med J 2018;21:31-6
|How to cite this URL:|
Adam VY, Aigbokhaode AQ. Sociodemographic factors associated with the healthcare-seeking behavior of heads of households in a rural community in Southern Nigeria. Sahel Med J [serial online] 2018 [cited 2018 Sep 24];21:31-6. Available from: http://www.smjonline.org/text.asp?2018/21/1/31/232781
| Introduction|| |
Good health is basic to human welfare and is a fundamental objective of social and economic development. Health seeking behavior relates to the willingness of an individual to seek help when ill and also where a person seeks medical care and preferable treatment among others. Studying health seeking behavior in a community is an important tool in understanding how healthcare facilities are utilized and identifying the determinants of poor utilization of available health-care facilities.
The behavior of individuals are influenced by belief systems, household decision-making to seek care, social network, and economic status. The factors affecting an individual's health seeking behavior vary between households and communities. Some of the factors reported by several studies that significantly affect the health seeking behavior of poorer households especially those in the rural areas include the availability of specialists; lack of resources and out-of-pocket financing of health-care services; sociocultural taboos and prevalence of traditional healthcare in the environment; poor access to good health-care services; and also the prevalence of traditional healthcare in the environment; educational attainment; family size; and perception of severity of illness.,,,
Poor healthcare-seeking behavior has been shown to contribute to ineffective prevention and control of morbidity and mortality related to health conditions.,, Self-treatment is usually the first line of management of many diseases in developing countries, many people have knowledge of common traditional treatments and most usually patronize readily available patent medicine dealers.
In Nigeria, over 60% of its population live in the rural areas. These areas are most neglected and deprived of modern health-care infrastructures and services that are essential for the promotion and maintenance of good health. In Edo State, 65% of the population live and work in rural areas where diseases and health-related conditions cause high morbidity and mortality. In addition, there is a wide gap between the desired and actual health-care services that the people get due to poor maintenance of civil infrastructures, lack of basic hospital equipment, lack of supportive services, poor quality of services, and poor facility utilization.
This study hoped to identify the factors associated with the healthcare-seeking behavior of heads of households in a rural community in Edo State, Southern Nigeria to provide appropriate interventions that could enhance and lead to sustenance of proper health seeking which would assist in promoting good health and management of health conditions.
| Materials and Methods|| |
This descriptive cross-sectional study was carried out between June and July 2014 in Ivhiunone (Ward 1), Fugar, a rural community in Etsako Central Local Government Area of Edo State. Fugar is located about 200 km from the state capital, Benin City, and is bounded to the North by North-Ibie, to the West by Uzairue, to the South by Ekperi and to the East by Weppa-Wano. As at the time of study, the community had a total population of 14,195 consisting of 3123 women of child-bearing age and 6756 children that are <15 years of age. The community is served by three primary health care centers and a secondary health facility.
A minimum sample size of 376 was calculated using the formula for minimum sample size determination in a descriptive study n = z2pq/d2. Taking P to be the percentage of women who received attendance from a skilled birth attendant at delivery to be 57.7%. A sample size of 410 was used for the study after adding a nonresponse rate of 10%.
A two-staged sampling technique was used. First, Fugar comprises three wards: Ivhiunone (Ward I); Ivhiarua (Ward 2); and Ivhiadachi (Ward 3). Ivhiunone was chosen using simple random sampling technique (balloting). Second, Ivhiunone comprises six settlements/clusters, of which four clusters were chosen using simple random sampling method (balloting). All the household heads or their adult representatives in the four clusters namely Ivhiavia I, Ivhiavia II, Ulumoghie, and Ivioromhia, were recruited for the survey. The houses in the chosen clusters were numbered, and questionnaires were administered to heads of households that were present and gave consent to participate in the study.
Data were collected using a structured interviewer-administered questionnaire adapted from UNICEF/IMCI Household Baseline Survey Questionnaire. Research assistants consisted of final year medical students of the School of Medicine, University of Benin. The occupation of respondents was classified into skill levels according to the International Labour Organization classification. The Nigerian currency, Naira (₦) was the unit for monthly income.
Data were analyzed using the IBM SPSS version 20 IBM SPSS version 20(IBM Corp., Armonk, New York) and Computer Program for Epidemiologists (PEPI [Sagebrush Press, Salt Lake City, Utah]) version 4.0 software. Data were presented as percentages, mean ± standard deviation and frequency tables. Chi-square test was used to test the association between socio-demographic/-economic characteristics and healthcare-seeking practice of the respondents with the level of significance set at P < 0.05.
Approval for the study was obtained from the Ethics and Research Committee of the University of Benin Teaching Hospital 12th March 2014. Permission to carry out the study was sought from the chairman of the LGA and sub-clan head of the community. Informed verbal consent was obtained from each of the respondents. Confidentiality and privacy of the respondents were respected during the interviews. Treatment of minor ailments, referrals and health education of the respondents on proper healthcare-seeking behavior was carried out immediately after data collection.
| Results|| |
A total of 410 household heads were interviewed, and almost all, 385 (93.9%) were of Etsako ethnicity. The mean age of the respondents was 49.5 ± 15.9 years.
More than half of the respondents, 259 (63.2%) were above 40 years. Over three-quarters, 357 (87.1%) and 346 (64.4%) were males and married respondents. The majority of the respondents, 372 (60.7%) had at least secondary level of education. Slightly over half of the respondents, 208 (50.7%) were in skill level 1 occupational classification [Table 1].
Almost all, 406 (98.8%) of the respondents sought healthcare when ill. Most respondents, 373 (91.9%) and 320 (78.8%) preferred to seek healthcare in patent medicine stores and hospitals respectively. Others, 36 (8.9%) and 65 (16.0%) preferred places of worship and traditional healers' place for healthcare. Most heads of households, 366 (90.1%); 305 (75.1%); and 268 (66.0%) preferred home treatment; doctors; and patent medicine dealers as healthcare providers, respectively. Over a quarter, 117 (28.8%) and less than a tenth, 16 (3.9%) preferred traditional healers and spiritualists as their health-care provider. Reported affordable places of seeking healthcare among respondents included patent medicine dealer shops, 382 (94.1%); primary health-care center, 354 (87.2%); secondary health facilities, 224 (55.2%); and tertiary health centers, 25 (6.1%), respectively [Table 2].
Age (P = 0.021); sex (P< 0.001); marital status (P< 0.001); level of education (P< 0.001), occupational classification (P< 0.001); and income level (P< 0.001) of the household heads had a statistically significant difference in association with the practice of seeking healthcare in the hospital (P< 0.05) [Table 3] and [Table 4].
|Table 3: Sociodemographic characteristics and healthcare seeking behaviour|
Click here to view
Using a binary logistic regression model, there was a 52.2%–79.3% variation in the health seeking behavior of the respondents. With a year increase in age, the respondents were 1.003 (P = 0.730; confidence interval [CI] =0.986–1.020), times more likely to have positive health seeking behavior. Respondents with at least secondary level of education were 0.445 (P = 0.007; CI = 0.248–0.798) less likely to have positive healthcare-seeking behavior than those with more than secondary level of education. The respondents who earn ₦50,000 or less were 0.297 (P = 0.014; CI = 0.112–0.785) times less likely to have positive health seeking behavior compared to those who earn more than ₦50,000 monthly. Unmarried respondents were less likely to have good health seeking behavior compared to those who were married by odds of 0.316 (P = 0.000; CI = 0.170–0.589) [Table 5].
|Table 5: Determinants of healthcare seeking behaviour among the respondents|
Click here to view
| Discussion|| |
A greater proportion of the respondents were older than 40 years of age, possibly because of migration of the younger population to the urban areas for better job opportunities and infrastructures. Most of the households in this study were headed by males. This finding of male predominance among household heads is similar to results from other surveys done in Nigeria.,,,
Furthermore, more than three-quarters of the heads of households were married, which is expected considering their mean age of 49.5 ± 15.9 years. With respect to the educational level of the respondents, the majority had secondary level of education in the community. A finding similar to Multiple Indicator Cluster Survey, 2011 carried out in Nigeria. This could be attributed to early age drop out from school and urge to settle down to married life and for independence, especially in the rural areas. It could also enhance regular health education sessions in the community on appropriate healthcare-seeking behavior, thus improving the general health of the populace.
Almost all the heads of households sought help when ill. This was similar to studies done in urban and rural communities in Iran  and Northern KwaZulu Natal  respectively, in which most of them sought help when ill. This finding may be attributed to the natural instinct for survival, irrespective of geographical location. This could lead to decrease in morbidity and mortality and also an increase in health status of the population if appropriate healthcare is sought.
In terms of preferred place for seeking health care amongst the heads of households, patent medicine stores were the most preferred source of health care for the community. This finding is similar to findings of studies conducted in Mali and Nigeria ,,,, in which a greater proportion of the respondents sought health care from the patent medicine stores/dealers and traditional healers than public health center. This could be explained by the fact that patent medicine stores and dealers are readily available in the rural areas  and the presence of traditional healers in the region, some of whom are registered by the Edo State Traditional Medicine Board. Another reason for this finding could be as a result of the poor state of public health institutions in the region. Furthermore, patent medicine stores were the most affordable place of treatment in the community. This inappropriate practice could result in varying degree of complications of health conditions. Improved quality of care provided to clients/patients in health-care facilities could address the inappropriate healthcare-seeking behavior in the community.
The use of medications in the community is commendable, as almost all the heads of households took medications when ill. However, there could be inappropriate prescription of medications with its consequences due to the high patronage of unorthodox healthcare providers and very high preference for home treatment in the study area. There is need to continually educate the community members on proper healthcare-seeking behavior to reduce the patronage of unorthodox health-care providers.
In this study, the sociodemographic predictors of healthcare-seeking behavior included marital status, level of education and income. However, variables such as age, sex, and marital status of the household heads were significantly associated with the practice of good healthcare-seeking in the hospital, except religion. With increasing age, there is a higher sense of responsibility of individuals with regards to health issues, and since most of the respondents are in the working age group and with different occupation, their income could be used to pay for health services rendered. In addition, spousal influence could have positive health effects on married respondents.
Religion was not significantly associated with healthcare-seeking in the hospital by the respondents, this probably could be due to the role of cultural norms, taboos, and myths as these sociocultural factors have been found to influence health-seeking practices  especially in the rural areas where these beliefs are strongly held unto despite religious affiliations. This was buttressed by the fact that in this study a quarter of the respondents still preferred to patronise traditional healers, a finding similar to a report from an Ibadan, Nigeria study.
In addition, the level of education, occupational class and monthly income which all determine the socioeconomic status of individuals, affected the health-seeking behavior of household heads in hospitals in the community. A finding that is similar to studies conducted in Nigeria.,,,, This could be because majority of the respondents had at least secondary level of education which could translate to better knowledge and practice of health-seeking behavior. Furthermore, there is a direct relationship between occupational status and level of income of the respondents which are also relatively tied to the level of education. The higher the occupational status, the more likely the pay and higher income and possibly, the better the healthcare-seeking practices of the people. This could lead to reduction in morbidity and its complications including mortality.
| Conclusion|| |
The sociodemographic predictors of healthcare-seeking behavior included marital status, level of education and income. Other associated factors were age, sex, and occupation. Most of the household heads preferred home treatment. Though a greater proportion of the respondents sought health care, this was more from patent medicine stores and the dealers. In addition, majority of them practiced self-treatment which results in self-medication especially as they favored the use of medications, this ultimately will result in delays in prompt and appropriate management and complications of morbidities in this rural community. Improved quality of care provided to clients/patients in healthcare facilities could address the inappropriate healthcare-seeking behavior in the community.
We humbly acknowledge the cooperation of the people of Ivhiunone and the Etsako Central Local Government Area Secretariat in conducting this survey. Furthermore, the 5th year medical students of the University of Benin who assisted in data collection are warmly appreciated. Special thanks also to the lecturers/resident doctors of the Department of Community Health, University of Benin/University of Benin Teaching Hospital, Benin City for their technical assistance.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Shaikh BT. Understanding social determinants of health seeking behaviours, providing a rational framework for health policy and systems development. J Pak Med Assoc 2008;58:33-6.
Uzochukwu BS, Onwujekwe EO, Onoka CA, Ughasoro MD. Rural-urban differences in maternal responses to childhood fever in South East Nigeria. PLoS One 2008;3:e1788.
Adedokun BO, Morhason-Bello IO, Ojengbede OA, Okonkwo NS, Kolade C. Help-seeking behavior among women currently leaking urine in Nigeria: Is it any different from the rest of the world? Patient Prefer Adherence 2012;6:815-9.
Onwujekwe O, Uzochukwu B, Eze S, Obikeze E, Okoli C, Ochonma O. Improving equity in malaria treatment: Relationship of socio-economic status with health seeking as well as with perceptions of ease of using the services of different providers for the treatment of malaria in Nigeria. Malar J 2008;7:5.
Dzator J, Asafu-Adjaye J. A study of malaria care provider choice in Ghana. Health Policy 2004;69:389-401.
Pourreza A, Khabiri R, Foroushani AR, Sari AA, Arab M, Kavosi Z. Health care-seeking behavior in Tehran, Islamic Republic of Iran. World Appl Sci J 2011;14:1190-7.
Ellis AA, Traore S, Doumbia S, Dalglish SL, Winch PJ. Treatment actions and treatment failure: Case studies in the response to severe childhood febrile illness in Mali. BMC Public Health 2012;12:946.
National Population Commission, Nigeria and ICF Macro. National Demographic and Health Survey (NDHS) 2013: Preliminary Report. National Population Commission, Abuja and ICF International; 2013. p. 8-45.
National Population Commission, Nigeria and ICF Macro. Nigeria Demographic and Health Survey (NDHS) 2008. Abuja: National Population Commission, Abuja and ICF Macro; 2009.
Omotosho O. Health-seeking behaviour among the rural dwellers in Ekiti State, Nigeria. Int Multidiscip J 2010;4:125-38.
Edo State Ministry of Health. Edo State Strategic Health Plan 2010-2015. Benin City: Edo State Ministry of Health; 2010. p. 1-139.
Etsako Central Local Government Area. Etsako LGA Projected Population and Work Plan for Routine Immunization 2014. Primary Health Care Department, Etsako Central LGA Secretariat, Fugar; 2014.
Cochrane WG. Sampling Techniques. 3rd
ed. New York: John Wiley and Sons; 1977.
United Nations Children Fund (UNICEF). Child Health/IMCI Household Baseline Survey. Draft Generic Tool Prepared by EPP/Evaluation and Health Section of UNICEF in Collaboration with IMCI Inter-Agency Working Groups; October, 1999. p. 24-36. Available from: https://www.unicef.org/health/files/health_generic.pdf
. [Last accessed on 2014 Dec 24].
International Labour Organization. International Standard Classification of Occupation: ISCO-08. Geneva: International Labour Office; 2012. p. 12-4.
Akande TM, Owoyemi A, Owoyemi JO. Healthcare-seeking behaviour in Anyigba, North-Central, Nigeria. Res J Med Sci 2009;3:47-51.
National Bureau of Statistics (NBS). Nigeria Multiple Indicator Cluster Survey (MICS) 2011: Main Report. Abuja: National Bureau of Statistics; 2013. p. 6-14.
Federal Ministry of Health. National HIV/AIDS and Reproductive Health Survey, 2012 (NARHS Plus). Abuja: Federal Ministry of Health; 2013. p. 56-81.
Case A, Menendez A, Ardington C. Health Seeking Behavior in Northern KwaZulu-Natal, South Africa: Irving B. Chicago; Illinois: Harris Graduate School of Public Studies, University of Chicago Press; 2005. p. 1-27.
Chukwuneke FN, Ezeonu CT, Onyire BN, Ezeonu PO, Ifebunandu N, Umeora MC. Health seeking behaviour and access to health care facilities at the primary level in Nigeria: Our experience. Ebonyi Med J 2012;11:51-7.
Oreagba AI, Onajole AT, Olayemi SO, Mabadeje AF. Knowledge of malaria amongst caregivers of young children in rural and urban communities in South-West. Trop J Pharm Res 2004;3:299-304.
Ige KO, Nwachukwu CC. Health care seeking behaviour among market traders in Ibarapa Central Local Government, Nigeria. Internet J Health 2009;9:1-13.
Adam VY, Aigbokhaode AQ. Healthcare seeking behaviour of heads of households in an urban community in South-South, Nigeria. Ann Biomed Sci 2015;14:121-30.
World Health Organization (WHO). World Health Statistics 2014 (Part III). Global Health Indicators. Geneva: World Health Organization; 2014. p. 59-176.
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5]