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Indian Journal of Community Medicine

Factors Determining Health Seeking Behaviour for Sick Children in A Fishermen Community in Pondicherry

Author(s): MB Sudharsanam, SB Rotti

Vol. 32, No. 1 (2007-01 - 2007-03)

In a country like India, the mortality of under-five children is mainly due to acute respiratory infections (23%) and diarrheal diseases (18%) as per WHO report 20021. However these may be very low estimates as many children may not be brought to an accountable health care facility and they go unnoticed. Therefore health seeking behaviour for such sick children and the factors which determine the treatment need to be assussed.

Material and Methods

The study was undertaken in a fisherman village, Veerampattinam, in Pondicherry Union Territory. The village houses a health subcentre manned by a multipurpose health worker. The nearest PHC is 4 Kms away and many private practitioners are available nearby. The study was carried out from March 2004 to June 2004. All children between 2 and 59 months of age were enrolled by house-to-house visit and the entire population was screened without any sampling. Sickness was defined as any child between 2 and 59 months, with fever (lasting at least 2 days) or acute respiratory infection or earache or diarrhea (2 episodes of watery loose stools for at least 1 day). A period of 2 weeks was chosen as the criterion to ensure better recall on the part of the mothers about the illness because these illnesses are supposed to recur frequently among children. An initial cross sectional survey was carried out by a houseto- house survey to determine the prevalence of sickness.

A pre-tested interview schedule was used to obtain the required information after getting informed consent from the respondent. Mothers were always preferred for interview. Out of 441 children, 406 were contacted for sickness screening by enquiring the mother. In those houses, which were locked at the time of the first visit, attempt was made to contact the children by making at least two more visits to the house. Inspite of these only 406 children could be met and 35 children (8%) were to be left out of the study. After an initial door-to-door survey, an age-matched child without sickness in the past 2 weeks was selected for each case and the health seeking behaviour was obtained for the current sickness for cases and previous sickness for controls. Details of age, sex, birth order, mother’s education and occupation, father’s occupation, number of persons and children in the family, monthly per capita income, immunization status for age, contraceptive practices followed in the family, system of medicine sought, nature of health care were sought from both the groups. Two focus group discussions were conducted, one each for mothers and fathers of under-five children to find the reasons for preferences for care and factors affecting their preferences.

Results

About 14% of the children were sick in the study period, which included acute respiratory infections (5.6%), acute diarrhea (4.7%), and fever (3.7%). All parents in both the groups sought allopathic system of medicine for sickness. About 65% of them sought private care. Table 1 reveals that gender is not playing a role in health seeking preferences as there was no gender differences in seeking private or government health care.(Chi-square-1.2 , p< 0.2). Table 2 shows the discriminant analysis for various predictor variables when private care versus government care was compared. It shows that sex of the child (canonical coefficient -0.290), birth order of the child (-0.322), number of children in the family (-0.032), maternal literacy (0.102) were not significantly associated with health seeking behaviour with private care. Parents who were below poverty line availed private health care in a significant level (0.548). Father’s occupation as fisherman influenced the most (1.00).

Table 1 : Association of Nature of the Health Care and Gender.

Nature
The health care
Females Males Chi square Odds ratio
Government sector 35 38 1.238 0.641
(P<0.266) (95%CI0.292-1.406)
Private sector 23 16    
Total 58 54    

In focus group discussion they told that they treat all their children alike and never discriminated male children from females. Few responses in this regard were as follows: “We have only two children, then why at all a difference?” “Ages of throwing away girl child have gone!!” “Both are my children. What is so special about a boy?” they always preferred allopathic system of medicine and private care. The various reasons were: “In private care they give powerful medicines that children get cured in 3 days.” “All the money and jewels are for our children. Money comes and goes sir… what if something happens to our child? That’s why we seek private care.” “Which Government hospital is open in the night?” “If there is recommendation only they (government doctors) see first… admit…” “I took my child on first day of fever… government doctor scolded me for bringing my child late.” Most of them preferred oral preparations to injections. Few responses were. “Syrup is best for kids. My doctor never gives injection.” “We can give same powerful medicines in tablets. Why injections?”

Table 2 : Discriminant Analysis of Factors Determining Health Seeking Behaviour for Private Care

Variables Canonical coefficient
Sex of the child -0.290
Birth order -0.322 Wilks lambda 0.908
Total children in the family -0.032
Maternal literacy 0.102 Group centroids
Father’s occupation 1.000 Government care 0.430
Economic status 0.548 Private care -0.230

Discussion

Our study showed a prevalence of 14% of sickness, which included acute respiratory infections (5.6%), acute diarrhea (4.7%), and fever (3.7%). These figures are very low when compared to all the other studies both in India and other developing countries. The National Family Health Survey-II showed that in India, among children upto three years, atleast 19% of the children suffered from diarrhea, 19% from ARI and 30% from fever, two weeks prior to the survey. In Tamilnadu, the nearby state, the survey revealed that the prevalence of fever-was 23%, diarrhea-14% and ARI 10%. On studying the factors affecting health seeking behaviour Taffa et al found in Nairobi that health care seeking was more for children below 1 year but our study showed that age group did not influence health seeking2. Sur et al found that in Kolkata 60% only went for allopathic system and 35% for private care for diarrheal episodes for the child, while our study showed 100% of them sought allopathic care and 65% private care3.

Pillai et al revealed no gender difference in seeking treatment but male children were taken to the alternative system of medicine but our study did not reveal any gender difference in seeking treatment or in the nature of health system approached4.

Schellenberg et al, have reported that there was association between socioeconomic status and health seeking behaviour; with low socioeconomic status people seeking frequently the government health care5. Pillai et al have reported the same type of association but our study showed that even people below poverty line sought private care4.

Focus group discussi ons revealed that there was no gender bias in health seeking behaviour as they gave equal importance to both males and females (“ellam nama petha pulla thane. Idhula enna vidyasam?”- Both are my children. Why at all a difference?). They all preferred allopathic system and private care due to the accessibility, (rathri nerathla endha government aspathri tharandhirukku sollunga?-.which government hospital is open in the night?) availability, and the way they are treated in government hospitals. (jorum vandha modhal nallula ittunu ponein… ivlo lateava kuttiyarudhunu ennaye thittraru doctoru!!! I took my child on the first day of fever to government hospital. He scolded me for bringing my child late.)

Conclusions

All parents sought allopathic system and majority, private care. No gender bias in health seeking preference. Birth order, number of children in the family, maternal literacy did not influence the health seeking behaviour. Inspite of low socio economic status they shought private care. Private care was preferred due to availability even in the evening and night, accessibility, quick relief and good individual attention.

References

  1. World Health Report, Geneva, WHO 2002.
  2. Taffa N, Chepngeno G: Determinants of health care seeking for childhood illnesses in Nairobi slums: Trop Med Int Health. 2005; 10:240-5.
  3. Sur D, Manna B, Deb AK, Deen J L, Danovaro-Holliday MC, von Seidlein L. Factors associated with reported diarrhoea episodes and treatment-seeking in an urban slum of Kolkata, India: J Health Popul Nutr. 2004; 22:119-29.
  4. Pillai RK, Williams SV, Glick HA, Poloky D, Berlin JA, Lowe RA. Factors affecting decisions to seek treatment for sick children in Kerala in India. Soc. Sci. Med Journal 2003; 57: 783-90.
  5. Schellenberg JA, Victora CG, Mushi A, de Savigny D, Schellenberg D, Mshinda H, Bryce J. Inequities among the very poor: health care for children in rural southern Tanzania. J Bio Soc Sci. 1992; 24:143-55.

Department of PSM Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry – 605006.
E-mail: [email protected]
Received: 18.7.05

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