DETERMINANTS OF CHOICE OF HEALTH FACILITY FOR REPRODUCTIVE MORBIDITY BY FEMALE TRADERS IN A NIGERIAN CITY

O. Ojifinni1, O. Ige2 and M. C. Asuzu1

1. Department of Community Medicine, University College Hospital, Ibadan, Oyo State, Nigeria

2. Global Ministries, Riverside Drive, USA

3. Department of Community Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria


ABSTRACT

Background: Reproductive health (RH) services are important to reduce reproductive morbidity and mortality. This is only possible if such services are used. Knowledge of the determinants of choice health facility for reproductive morbidity is useful to design interventions aimed at increasing utilization of RH services. 

Objective: This study therefore explored the determinants of choice of health facility for reproductive morbidity among female traders within Ibadan metropolis.

Methods: This was a cross-sectional study using interviewer-administered questionnaire among 410 female traders aged 15-49 years selected by systematic random sampling in Aleshinloye market in the city of Ibadan, Nigeria. Government and private hospitals were classified as orthodox health facilities. Data was analysed using logistic regression at 5% significance level.

Results: Mean age was 34.6 ± 7.8, 78.2% were married and 58.7% had secondary education. Above half (52.9%) used orthodox health facilities. Perceived quality of care influenced the use of orthodox facilities and likelihood of using the same facility in the future. Factors predicting the use of orthodox health services were social economic status (OR 2.77 95%CI 1.06-6.73), delay in attaining conception (OR 2.70 95%CI 1.39-5.22), menstrual problems (OR 2.15 95%CI 1.19-3.90) and complications in previous pregnancy (OR 2.11 95%CI 1.21-3.78).

Conclusion: The use of orthodox health facilities was affected by respondents’ past experience of reproductive morbidity and socioeconomic status. These factors should be borne in mind in planning interventions for improvement in reproductive health service utilisation.

Keywords: Reproductive morbidity, Orthodox healthcare services, Healthcare seeking behaviour, Female traders, Nigeria


INTRODUCTION

The need to improve health service utilization for the reduction of reproductive morbidity and mortality has been documented and has prompted interest in the choices people make with respect to seeking care when morbidities occur 1-6. MacKian proposed that individuals make decisions in relation to their health after weighing the potential risks and benefits of the particular behaviour in a way that is mediated by their practical environment, their social rootedness and their whole outlook on life generally7. The choice of healthcare facility for any health problem will therefore be determined by a person’s current situation vis-a-vis financial status, social standing and previous experiences.

With respect to reproductive morbidity and healthcare seeking behaviour among women, the factors affecting choice of healthcare include beliefs about the cause of the symptom being experienced, the perceived consequences of the symptom, financial capacity at the time of illness and the constraints faced in situations where they decide to seek help but are unable to 6,8-10. The educational and economic status,6,11,12 decision making capacity2,6 as well as control over household income is positively associated with an individual’s ability to seek healthcare 1,12,13. Other factors that have been shown to affect choice of healthcare provider for reproductive morbidity include wealth status 6,11,14, perceived severity of illness 11,15, cost of care11,15, proximity to the healthcare facility6,16, type of illness reported.8,17 The use of orthodox health facilities for reproductive morbidity may also be affected by socio-cultural values and beliefs where the perception that the illness will resolve without intervention prevents women from seeking care early. Feelings of shame associated with symptoms such as vaginal discharge or genital sores may prevent the use of health facilities.2 On the other hand, confidence and friendliness of the health staff, encouraging staff attitudes, a sense of privacy and belief in the confidentiality of information provided may encourage the use of health facilities.4,14,18

Global economic and social changes have led to more women working outside the home especially in the informal sector. In an environment where a high premium is placed on reproduction, the effect of strenuous work in the informal sector has implications both for general and reproductive health. While choices of healthcare for general illness has been assessed in different areas of the country, 14,18,19 there is paucity of information about choice of healthcare facilities in the event of reproductive health problems among women. This study was carried out to examine the utilization of healthcare services in the event of reproductive illness among female traders within the Ibadan metropolis.

METHODOLOGY

Study area

The study was carried out in Aleshinloye market, a major market in Ibadan metropolis. Located in Ibadan South-West Local Government Area (LGA) of Ibadan, Aleshinloye market was established by the Oyo State Government in 1990. The market consists of 4,926 shops ranging in size between 5 × 10 feet and 10 × 10 feet, laid out in sections arranged by the wares sold ranging from clothing to household utilities and foodstuff. The facilities available in the market include parking lots, toilets, a fire station and motorable roads. There is also a Primary Health Care facility within the market under the supervision of the Medical Officer of Health of the Ibadan Southwest LGA.

Study design

A descriptive, cross-sectional study was carried out among female traders in Aleshinloye market to explore the determinants of healthcare seeking behaviour for prevalent reproductive health problems.

Sampling

The study population was female traders between ages 15 and 49 years in Aleshinloye market. The sample size was determined using the Leslie Kish formula20 for calculating sample size for single proportion for descriptive studies. Using an assumed prevalence of 50% at 95% confidence interval and giving a 10% allowance for non-response, a minimum sample size of 410 was calculated for the study. Assuming one female trader would be selected from each shop, the number of shops in the market was used as a proxy for the number of female traders. A systematic random sampling method was used to select the study participants. The sampling interval of 12 (410/4926 ~ 1/12) was used to select shops after selecting the first shop by balloting. In shops where there was more than one female trader, the study participant was selected by balloting.

Data collection

The data collection tool was a semi-structured, interviewer administered questionnaire developed by drawing on relevant literature including the Nigerian Demographic and Health Survey (NDHS). The questionnaire was translated to Yoruba, the local dialect for easier administration and pre-tested in Mokola Market located in Ibadan North Local Government Area then modified based on the results generated prior to the survey. Five female research assistants with post-secondary education were recruited and trained to conduct the data collection. The training which was conducted over a two-day period in May 2010, involved a review of the instruments in both English and Yoruba. Pre-test of the instrument was done on the second day of the training with the research assistants administering the questionnaires in preparation for actual data collection. All problems identified with the sampling process, phrasing of questions in the instrument and conduct of the interviews were addressed during a debriefing session. Data collection was between May and June 2010.

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