ABSTRACT
The purpose of this study was to
Factors Influencing Health Seeking Behavior among Women Attending Antenatal
Care in Selected Health Centres in Ekpoma, Edo State. The population for this
study comprised women of childbearing age (15 – 45 years) attending antenatal
care in Esan West Local Government Area of Edo State. Using a simple random
sampling technique to select a sample of one hundred 100 pregnant women
attending antenatal care in primary health care centres in Esan West Local
Government Area, the researcher solicited responses by issuing out a structured
questionnaire which was later analyzed through frequency counts and simple
percentages. The study found that cultural beliefs,
socio-economic status, geographical location and quality of service delivery
are the major factors affecting the health-seeking behaviours of women in Esan
West Local Government Area of Edo State, lack of money to pay for hospital
bills can discourage women altogether from visiting the hospital for any reason
and concerning quality of services delivery the study identifies slow
responses, and lack of positive gesture from hospital workers was very
influential in determining the decision of women to seek medical care in
hospitals. Following these findings the study recommends among others that members
of the communities should be sensitized toward the use of health care
facilities, people should be educated on the effects of importance of choosing
the right health care, especially during pregnancy and the government should
work with religious and union bodies to re-educate members on the importance
and interdependent nature of religion and health.
TABLE
OF CONTENTS
CHAPTER ONE
INTRODUCTION
1.1 Background to the Study
1.2 Statement of Problem
1.3 Purpose of the Study
1.4 Research Questions
1.5 Significance of the Study
1.6 Scope/Delimitation of the Study
1.7 Definition of Terms
CHAPTER TWO
REVIEW OF RELATED LITERATURE
2.1 Conceptual Review
2.1.1 Meaning of
Health
2.1.2 Health Seeking Behaviour
2.1.3 Factors
Influencing Heath Seeking Behaviour
2.1.4 Antenatal Care
2.2 Theoretical
Review
2.2.1 Health Belief
Model (HBM)
2.3 Empirical Review
2.3.1 Health Seeking
Behavior among Pregnant Women Attending Antenatal Care
2.3.2 Application of
Health belief Model
2.4 Summary
CHAPTER THREE
METHOD OF THE STUDY
3.1 Research Design
3.2 Research Setting
3.3 The population of the study
3.4 Sample determination
3.5 Sampling Technique
3.6
Instrument
for Data Collection
3.7
Validity
of the instrument
3.8
Reliability
of Instrument
3.9 Method of Data Collection
3.10
Method of Data Analysis
3.11 Ethical
Considerations
CHAPTER FOUR
DATA ANALYSIS AND DISCUSSION OF
FINDINGS
4.1 Demographic Analysis of Respondents
4.2 Analysis
of the Research Questions
4.3 Discussion of Findings
4.3.1
Implication of findings with literature
support
4.3.2
Aligning findings with previous studies
cited
CHAPTER FIVE
DISCUSSION OF FINDINGS
5.0 Introduction
5.1 Summary
5.2
Conclusion
5.3 Recommendations
5.4
Suggestion
for Further Studies
5.5
Implication
for Nursing
5.6
Limitations
of the Study
References
Appendix: Questionnaire
CHAPTER ONE
INTRODUCTION
1.1 Background to the Study
Health-seeking behavior
(HSB) refers to any step or
action employed by individuals in response to perceived illnesses towards finding
a cure or required treatment (Latunji & Akinyemi, 2016). Health-seeking
behavior can also be referred to as sick-term behavior (or an individual’s
behavior during those times) with emphasis on the sequence of remedial actions
taken to rectify perceived ill-health (John & Peter, 2010). Health-seeking
behavior is situated within the broader concept of health behavior, which
encompasses activities undertaken to maintain good health, prevent ill health,
as well as deal with any departure from a good state of health (Latunji &
Akinyemi, 2016).
Various studies have
attempted to describe factors that significantly affect health-seeking behavior
during illness episodes. These studies can be broadly classified into two
groups. The first group is studies that emphasize the utilization of the formal
system or the “healthcare-seeking behavior” of people. These studies
focus on the tendency of individuals to take advantage of available health
services and facilities (Sara, 2011). The studies that fall under this category
involve the development of models that describe the series of steps people take
toward healthcare. These models are sometimes referred to as “pathway models”.
While there are several variations of these models, the Health Belief Model and
Andersen’s Health Behaviour Model are often used as a basis in discussions
involving health-seeking. The second group comprises those studies which
emphasize the “process of illness response” or “health-seeking behavior”.
These studies focus on why individuals decide to, or not, seek remedies for health-related
issues, as well as the reason behind preferred channels of help. These
studies are founded on the basic assumption that the decision to engage with a
particular medical channel is influenced by a variety of factors such as socioeconomic
status, sex, age, the social status, the type of illness, access to services,
and perceived quality of the service (Sara, 2011: Latunji and Akinyemi, 2016).
Majority of the studies under this second category focus on specific genres of
determinants that lie between patients and services such as geographical,
social, economic, cultural, and organizational factors (Latunji and Akinyemi,
2016). ). Latunji & Akinyemi, (2018), found in their study
on the factors influencing health-seeking behavior among civil servants
in Ibadan, Nigeria, that health-seeking behavior was high among civil servants. This
according to them was an indication of the influence of socio-economic status
and the level of education on health-seeking behavior.
Health-seeking
behaviors (HSB) are closely linked with the health status of a nation and thus
its economic development. Several factors have been identified to influence the
health-seeking behavior of individuals such as socio-economic status,
sex, age, the type and severity of illness, access to services, and perceived
quality of the service (Akeju, et al, 2016).
Maternal mortality or
maternal mortality ratio (MMR) is defined as the number of maternal deaths
during a period per 100,000 live births during the same period (World Health
Organization, WHO, 2017). It depicts the risk of maternal death relative to the
number of live births and essentially captures the risk of death in a single
pregnancy or a single live birth. The annual number of female deaths from any
cause related to or aggravated by the pregnancy or its management (excluding
accidental or incidental causes) during pregnancy and childbirth or within 42
days of termination of pregnancy, irrespective of the duration and site of the
pregnancy, expressed per 100,000 live births, for a specified period (United
Nations Children’s Fund, UNICEF, 2017).
The maternal mortality
ratio (MMR) in several low-and-middle-income countries is alarming, with about
34% of global maternal deaths occurring in Nigeria and India alone (Nicholas,
2022). According to the World Health Organization, WHO, (2022), the MMR of
Nigeria is 814 (per 100,000 live births). The lifetime risk of a Nigerian woman
dying during pregnancy, childbirth, postpartum or post-abortion is 1 in 22, in
contrast to the lifetime risk in developed countries estimated at 1 in 4900
(Nichollas, 2022). Current evidence suggests that the high rate of maternal and
neonatal mortality in Nigeria is linked to the three forms of maternal delay
proposed by Thaddeus and Marine. These barriers include delay in making
decisions to seek maternal health care; delay in locating and arriving at a
medical facility; and delay in receiving skilled pregnancy care when the woman
gets to the health facility.
To address the
challenges associated with the three delays which prevent women from receiving
adequate timely maternal health care, some studies recommended improving access
to skilled birth attendance (SBA), especially through better quality Primary
Health Care (PHC). This is because Nigeria has about 34,000 PHCs (entry point
level) covering all health wards and hard-to-reach communities. Hence,
improving the accessibility, availability, affordability, and care quality in
PHCs will most likely reduce the high rate of neonatal and maternal mortality
in Nigeria. Another study stated that maternal mortality in Nigeria would
reduce if there is an improvement in the quality of care provided within
tertiary health facilities (second-level referral). The authors emphasized that
the inability to get quality health services in most Nigerian health
institutions contributes greatly to the high maternal deaths in the country
(Donna and Hoyert, 2022).
Additionally, WHO
associated the high prevalence of maternal death in Nigeria with inequalities
in access to health services as women in resource-poor settings are least
likely to receive adequate, timely, and affordable health services by skilled
personnel compared to their counterparts in more developed countries. Although
the evidence towards reducing maternal mortality through access to skilled
pregnancy care is largely relevant, it remains inadequate in ensuring a
substantial decline in maternal deaths in Nigeria. Improving the quality of
health services goes beyond assessing only the supply aspect of care. Some
authors noted that even if the standard of services in Nigerian primary,
secondary or tertiary health facilities is improved, maternal mortality may
still be high (Nicholas, 2022). This is because an increase in the quality of
care provided at a health institution does not always translate to an increase
in the utilization of health services by women. Most times, the choices that
these women make in the utilization of a health facility are based on their
perception of care, and not on the actual quality of care being delivered.
From 2000 to 2017, the
global maternal mortality ratio declined by 38 percent – from 342 deaths to 211
deaths per 100,000 live births, according to UN inter-agency estimates. This
translates into an average annual rate of reduction of 2.9 percent. While
substantive, this is less than half the 6.4 percent annual rate needed to
achieve the Sustainable Development global goal of 70 maternal deaths per
100,000 live births (United Nations Population Division, UNPD, 2017). There has
been significant progress since 2000. Between 2000 and 2017, South Asia
achieved the greatest overall percentage reduction in MMR, with a reduction of
59 percent (from 395 to 163 maternal deaths per 100,000 live births).
Sub-Saharan Africa achieved a substantial reduction of 39 percent in maternal
mortality during this period. Two regions, sub-Saharan Africa and South Asia
account for 86 percent of maternal deaths worldwide. Sub-Saharan Africans
suffer from the highest maternal mortality ratio – 533 maternal deaths per
100,000 live births, or 200,000 maternal deaths a year. This is over two-thirds
(68 percent) of all maternal deaths per year worldwide. South Asia follows,
with a maternal mortality ratio of 163, or 57,000 maternal deaths a year,
accounting for 19 percent of the global total. Furthermore, regional and global
averages tend to mask large disparities both within and between countries (WHO,
UNICEF, UNPD, and World Bank, 2017). Every region has advanced,
although levels of maternal mortality remain unacceptably high in sub-Saharan
Africa. Almost all maternal deaths can be prevented, as evidenced by the huge
disparities found across regions and between the richest and poorest countries.
The lifetime risk of maternal death in high-income countries is 1 in 5,400,
compared to 1 in 45 in low-income. The global lifetime risk of maternal death
nearly halved between 2000 and 2017, from 1 in 100, to 1 in 190.
Hemorrhage remains the
leading cause of maternal mortality, accounting for over one quarter (27 percent)
of deaths (WHO, 2020). A similar proportion of maternal deaths were caused
indirectly by pre-existing medical conditions aggravated by the pregnancy.
Hypertensive disorders of pregnancy, especially eclampsia, as well as sepsis,
embolism, and complications of unsafe abortion also claim a substantial number
of lives (UNICEF, 2021). The complications leading to maternal death can occur
without warning, at any time during pregnancy and childbirth. Most maternal
deaths can be prevented if births are attended by skilled health personnel –
doctors, nurses, or midwives – who are regularly supervised, have the proper
equipment and supplies and can refer women promptly to emergency obstetric care
when complications are diagnosed. Complications require prompt access to
quality obstetric services equipped with life-saving drugs, including
antibiotics, and the ability to provide blood transfusions needed to perform
Cesarean sections or other surgical interventions.
1.2 Statement of Problem
According to World
Health Organization (WHO, 2019), Nigeria accounts for over 34 percent of
maternal deaths during pregnancy worldwide. The February 2022 ranking of
maternal mortality in Africa places Nigeria comfortably at the top of the chart
with 917 per 100,000 births. Mauritania with 766, Lesotho with 544, and
Cameroon with 529 are the closest in the ranking (World Bank, 2022). The
lifetime risk of dying during pregnancy, childbirth, postpartum, or after an
abortion for a Nigerian woman is 1 in 22, compared to 1 in 4900 in developed
countries (Nicholls, 2022). Preventing maternal mortality and improving
the maternal health of Nigerian women, therefore, becomes a matter of national
priority and utmost urgency. To achieve the Sustainable Development Goals
(SDGs) for maternal and newborn health (MNH) in Nigeria by 2030, the number of
maternal fatalities will have to be less than 300/per 100,000.
The causes of maternal
mortality are not evenly distributed, and this discrepancy is due to social
determinants of health and health system shortcomings. As a result, the risk of
maternal death is higher in socially deprived communities because these women
are more likely to have an unwanted pregnancy than women with financial and
social resources. Education, income, and occupation are all intertwined and
influence access to social opportunities. As a result, they play a critical
role in maternal mortality reduction. Despite the high disparity in the rate of
maternal mortality among various groups, the causes of maternal mortality are
mostly preventable through positive health-seeking behaviors. Thus the highest
independent factor responsible for maternal death is individual variance in the
health-seeking behavior of women, especially during pregnancy.
Various factors have
been identified by researchers as being responsible for the poor health-seeking
behavior of expectant mothers, especially in rural communities. In light of the
foregoing, this study seeks to evaluate the factors influencing health-seeking
behaviors among pregnant women attending antenatal clinics in selected health
centers in Ekpoma Edo State.
1.3 Purpose of the Study
This study seeks to
evaluate the factors influencing health-seeking behavior among pregnant women
attending antenatal clinics in selected health centers.
Specifically, it aims at
evaluating the:
- Influence of cultural beliefs
on the health-seeking behavior of pregnant women attending antenatal
clinic in selected health care centres, Ekpoma Edo state.
- Socioeconomic status affects
the health-seeking behavior of pregnant women attending antenatal clinic
in selected health care centres, Ekpoma Edo state.
- Influence of gender autonomy on
the health-seeking behavior of pregnant women attending antenatal clinic
in selected health care centres, Ekpoma Edo state.
- Geographical location effects of
the health-seeking behavior of pregnant women attending antenatal clinic
in selected health care centres, Ekpoma Edo state.
- Quality of service that influences
the health-seeking behavior of pregnant women attending antenatal clinic
in selected health care centres, Ekpoma Edo state.
1.4 Research Questions
- What are the factors influencing
the health-seeking behavior of pregnant women attending antenatal care in
selected health centres, Ekpoma Edo state?
- What is the influence of
cultural beliefs on the health-seeking behavior of pregnant women
attending antenatal clinic in selected health care centres, Ekpoma Edo
state?
- How does socioeconomic status
affect the health-seeking behavior of pregnant women?
- What is the influence of gender
autonomy on the health-seeking behavior of pregnant women attending
antenatal clinic in selected health care centres, Ekpoma Edo state?
- What is the geographical
location that affect the health-seeking behavior of pregnant women
attending antenatal clinic in selected health care centres, Ekpoma Edo
state?
- What are the quality of services
that influence the health-seeking behavior of pregnant women attending
antenatal clinic in selected health care centres, Ekpoma Edo state?
1.5 Significance of the Study
It is expected that this
study would;
- Help identify the factors
responsible for health-seeking behavior among pregnant women in Ekpoma and
environs.
- The findings of this study will
shed light on the need for proper health-seeking behavior in combating
maternal mortality in the region.
- It is expected that this study
will act as a tool for detecting early, health-related issues, especially
those associated with pregnancy and delivery, and prompt treatment before
it results in complications.
- It will serve as a guide for
further studies.
1.6 Scope/Delimitation of the Study
This research work is delimited
to Ekpoma, Esan West Local Government Area of Edo State. The study is delimited
to the assessment of “health-seeking behavior” (referring to the study decision
making behind health-seeking actions and options) and does not cover
“healthcare-seeking behavior” which focuses on the rate of utilization of
public health services and facilities.
1.7 Definition of Terms
- Antenatal care: Is an umbrella term used to
describe the medical procedures and care that are carried out during
pregnancy.
- Health-seeking Behavior: refers to the sequence of
remedial actions taken to rectify perceived ill-health.
- Health clinics: Medical centers that are
focused on outpatient services (allow patients to go home immediately
after treatment).
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