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Indian Journal of Community Medicine

Health Care Seeking Behaviour with Special Reference to Reproductive Tract Infections and Sexually Transmitted Diseases in Rural Women of West Bengal

Author(s): A. Saha, A. Sarkar, N.C. Mandal, J.C. Sardar

Vol. 31, No. 4 (2006-10 - 2006-12)

A. Saha, A. Sarkar, N.C. Mandal, J.C. Sardar

Introduction

Sexually transmitted diseases are a major cause of morbidity among men and women in the developing countries, women being twice as likely to suffer after just one exposure1. The threat of Acquired Immunodeficiency Syndrome (AIDS) focused greater attention on Sexually Transmitted Diseases (STD) and Reproductive Tract Infections (RTI)2. However in spite of the availability of low cost and appropriate technologies to manage RTIs and STDs in the primary health care setting most of the sexually transmitted infections remain hidden and unrecorded and a very small proportion of people (5-10%) suffering from the disease attend government health facilities3. There have been relatively few studies on of health care seeking behaviour in relation to Sexually Transmitted Diseases (STD) and Reproductive Tract Infections (RTI) of women in rural areas. Keeping the above mentioned facts in view current study was undertaken to study health care seeking behaviour of ever married women aged between fifteen and forty-four years with special reference to those who had one or more symptoms of reproductive tract infection or disease.

Materials and Methods

This cross-sectional study was conducted in a rural area of West Bengal (Singur Block of Hooghly District) for a period of one year from August 1998 to July 1999. The study population comprised of ever-married woman between fifteen to forty-four years. There were altogether seven PHCs in the block (three under RHU&TC and rest under Singur Rural Hospital). A multistage sampling procedure was followed for selection of villages. From the list of PHCs, 2 PHCs under RHU&TC and 2 PHCs under Singur Rural Hospital was selected using simple random sampling, then a list of villages under each selected PHCs was compiled and one village from each PHC was finally selected using simple random sampling technique to provide four study villages. In each village, 15% of all the households were selected using systemic random sampling technique. Total number of households in four villages was 830. Considering drop out of 5% of the sample and after rounding off, finally 131 households were selected. From each household one eligible woman in the age group between fifteen to forty-four years was interviewed and thus final sample size of respondents was 131. The primary tool in this study was a pre-designed pre-tested semi-structured questionnaire covering information on their socio-demographic profile, gynaecological morbidities with reference to syndromic approach, care seeking behaviour during illness and utilization of government and private health care facilities.

Results and Discussion

Majority of the study subjects were in the age group of 25- 34 years (45.1%), mean age being 27.4 years. 80% of them were literate with 55.8% educated up to secondary level. 56.5% households had nuclear structure. 26.7% of the respondents belonged to lowest income category. All the 131 women surveyed were married, three of them were separated from their spouse and one was widow. 124 of them had had previous childbirth, two were pregnant for the first time and five had never experienced pregnancy.

Majority of the women (80.9%) mentioned that the first persons they informed at the time of common illness was their husband but for ‘gynaecological symptoms’ the proportion came down to 54.2%. The findings corroborated with the findings of Khan et al (1997)4 The sharp change in behaviour was statistically significant (p<0.01) but husband remained the commonest person first informed. (Table-I)

Table I: Distribution of the Respondents According to their Care-Seeking Behaviour (n=131)

Care- seeking
behaviour
For common
illness
For gynaeco-
logical
symptoms
p- Value
No. % No. %
First person informed
Husband 106 80.9 71 54.2 <0.01
Mother in-law 14 10.7 9 6.9  
Others 6 4.6 8 6.1  
None 5 3.8 43 32.8 <0.01

Table II: Distribution of the Respondents According to their Utilizationof Health Care Facility (n=131)

Govt. Clinic
Health Care
Facility
Utilised Not Utilised Utilisation
Rate %
p – value
For ANC 92 32 74.2 <0.0
For gynaccological
Symptoms
26 105 19.8  
Private Clinic
for ANC
28 96 22.6 <0.0
For Gynaccological
Symptoms
59 72 45.0  

It was observed from table-II that 74.2% respondent preferred government health care facility for antenatal care and only 19.8% for ‘gynaecological symptoms’ and the difference was statistically significant (p<0.01). Similar comparison in private health care facility for ‘gynaecological symptoms’ but only 22.6% utilized it for antenatal care. The difference was also found statistically significant (p<0.01). Respondents’ preference for government health care facility for antenatal care was significantly higher than their preference for private health care facility (p<0.01). Private clinic as preferred source of treatment for RTI and STDs was also observed in other studies5.

Reason for choosing one health care provider over another was mostly due to faith in quality of health care (58.8%) followed by accessibility (19.1%). Cost of care, provision of privacy and sympathetic behaviour were also predictor of choice but to a much lesser degree (8.4%, 7.6% and 6.1% respectively). Family structure, socio-economic status and literacy status did not significantly affect the health seeking behaviour in this study sample.

Conclusion and recommendation

It can be concluded that improvement of the quality of service at PHC level for RTI and STDs is urgently needed to improve acceptability of government health care services for women’s sexual health in general and STD services in particular. For this more intensive training of primary health care worker in managing the problem at PHC level through syndromic approach, training on right attitude and behaviour including gender training is essential.

References

  1. Lande R. Controlling Sexually Transmitted Diseases. Population Reports. L(9).1993.
  2. Barge S. Gynaecological Morbidity-The ignored tragedy. J Family Welfare.1997,43:58-67.
  3. Combating HIV/AIDS in India, 1999-2000: Govt. of India, Ministry of Health and Family Welfare, National AIDS Control Organisation.
  4. Khan MA, Rahaman M, Khanam PA, et al. Awareness of sexually transmitted diseases among women and service providers in rural Bangladesh. Int J, STD AIDS. 1997;8:688-96.
  5. Roy V, Bhargava P, Bapra JS, Reddy BS. Treatment seeking behaviour in sexually transmitted diseases. Indian J Public Health. 1998;42:133-5.

Department of Preventive and Social Medicine, All India Institute of Hygiene and Public Health, Kolkata-700073
E-mail: [email protected]
Received: 2.2.05

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