1.1 Introduction
Health seeking behaviour refers to all those things humans do to prevent diseases and detect diseases in their asymptomatic stages. In contrast, illness behaviour refers to all those activities designed to recognize and explain symptoms felt by an ill person and sick role behaviour refers to all those activities designed to cure diseases and restore health after a diagnoses has been made (Kraszewski, 2009). Health seeking behavior is a multi-dimensional concept. The definition of this concept varies depending on the attributes used and the context emphasized. In a broader sense, it refers the action and practice undertaken by an individual to be healthy and remain free from the occurrences of disease (Sen, 2012). Health seeking behavior and health care seeking behavior are not one and the same.
This chapter will address the background information that motivated this study, the challenges that prompted it, its aim, and its objectives as a preface to subsequent sections of the study. Additional factors include the study's significance, scope, limitations, research questions and hypotheses, and the definition of technical terms.
1.2 Background of Study
A woman's health care seeking behaviour during pregnancy depends a great deal on her beliefs, culture, experience, educational level, financial status, attitude towards pregnancy, as well as her autonomy and decision making power. Adele (2010)suggests issues of importance to include information about pregnancy the woman's family communicated to her as a child and whether the pregnancy was planned or unplanned. Garba, Hellandendu, andAjayi (2011) further explained that long before the advent of modern scientific medicine, most cultures have among their patterns of life, a body of beliefs and practices that centre on the recognition and treatment of complications of pregnancy and conduct of deliveries. Thus, an understanding of appropriate health care seeking behaviour is very important in achieving the desired pregnancy outcome. Negative behaviour is highly implicated in increased morbidity and mortality of mother and baby.
Osubor, Fatusi, and Chiwuzie (2006),suggests Maternal Health Care Seeking Behaviour (MHCSB) to include the number of visits made to antenatal clinic (ANC) by pregnant women and their preference for place of delivery.Jain, Nandan and Misra (2006) defined health seeking behaviour as “a complex outcome of m any factors operating at individual, family and community levels including their biosocial profile, past experiences with health services, availability of alternative health care providers, and the people's perception regarding the efficacy and quality of the services” .
Adele (2010) explains health seeking behaviour to be those activities undertaken by individuals in response to any discomfort felt. He further stated that in the developed countries like United States of America (USA), most women visit ANC early in pregnancy, comply with prenatal directives and are attended to by skilled health care providers when in labour. He also suggests that in the developing countries, especially in the rural sub-Saharan Africa, most women consider pregnancy a natural process and the services of skilled health care providers deemed not necessary. Rastogi (2012) observed low utilization of ANC among rural women in India due to lack of means of transportation, also because the women were often shy when discussing their health problems before a male professional. Rastogi suggests that women who had formal education up to secondary school level sought health care from skilled providers.
Since maternal health care relies on the entire health system of a country, its outcomes including health-seeking behavior can be traced from the way health systems operate (Parkhurst et al., 2005). The health system includes the human resources, organization of maternal health services which dwells on the availability of both private and public sectors, and reforms in the health sector (Graham, 2002). These are in general, what Nigeria's maternal health service is dependent on, and have various implications for maternal health-seeking behavior. This section of the paper discusses these elements in the health system.
Maternal mortality ratio in sub-Saharan Africa alone has reduced by only 1.6% per annum since 1990 while other regions like the East Asia and the Pacific regions have seen on average an annual decline of 4.5%. It is expected that a 5.4% decline per annum is required to achieve the millennium development targets in the sub-Saharan African region (Wagstaff et al., 2004).
In Nigeria, women are said to be mothers of all, because they are usually the bearer of pregnancy, that is, the role of child bearing is traditionally assigned to them (Ogunjuyigbe, 2000). Thus pregnancy is one of the most important events in the life of every woman and it is also a dynamic process in which a woman's risk status can change at any point in time (WHO, 2000). Hence, pregnant women can be said to be at risk of developing some health problems such as anaemia, fever, malaria, excessive fatigue, diarrhoea, reproductive tract infections, sexually transmitted infections, headache, backache, swelling, cramps (Chamberlain, 2001).
Furthermore, their health seeking behaviour can be influenced by some factors such as cultural factors (which includes low status of women in the sense that they take authority from their husbands before taking/seeking medical aid), social factors like sex, age, educational level, marital status, occupation. Societal factors may include growth and equity, peer pressure, governance(which include overall approach of government toward health of the state), socioeconomic factors like standard of living, economic status/income, religion, cost of care, the type and severity of illness, geographical factors such as bad roads, weather/climatic changes, physical factors like the attitudes of health care personnel, long waiting at the healthcare centres/time wasting, standards of equipment, standard and availability of essential drugs, cost of care not equal to services rendered, interpersonal relationship between the health care team (Borras, 2004).
It may seem right to discuss maternal health outcomes based on only how maternal health service is organized or on how it is financed. But such discussions may lead to a one-sided finding, if not biased outcomes. Therefore, in Nigeria where the research was carried out, the activities that was conducted is to know the Maternal Health Seeking Behaviors and Pregnancy Outcome.
1.3 Statement of Problems
Investigation revealed that in recent years, health promotion programmes worldwide have been premised on the idea that providing knowledge about causes of ill health, choices and health care available. This had gone a long way towards promoting a change in individual behaviours towards more beneficial health seeking behaviours.
However, owing to the difference in people's opinion on where and when to seek health care services and also from the review of available literature, it shows that no study has been carried out to determine the health seeking behaviour amongst pregnant women attending antenatal clinic in health centres in Enugu State, especially in Nnewi North. Thus the researchers decided to embark on this study
1.4 Aim and Objectives of Study
The aim of the study is to scrutinize the Maternal Health Seeking Behaviors and Pregnancy Outcome. In achieving this aim, the following specific objectives were laid out as follows:
- To determine the types of maternal health problems experienced by pregnant women,
- To ascertain their opinions towards the causes of their maternal health problems,
- To identify their reasons of choosing those places for maternal health care,
- To determine their opinion of suitable places to seek for maternal health care, and
- To find out the factors that influences their maternal health seeking behavior and pregnancy outcome.
1.5 Research Questions
The study came up with research questions so as to be able to ascertain the above stated objectives. The specific research questions for the study are stated below as follows:
- Are there factors that influence their maternal health seeking behavior and pregnancy outcome?
- What are the opinions towards the causes of their maternal health problems?
- What are the reasons of choosing those places for maternal health care?
- What are the opinions of suitable places to seek for maternal health care?
- What are the types of maternal health problems experienced by pregnant women?
