Author Topic: Health seeking behaviorin Bulo-Marer community and surrounding villages  (Read 7878 times)

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Offline dr-awale

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Date: -1/April /2008



 




                         Department community health /faculty of medicine  
                                             Benadir university
                                             Mogadisho City
                                                 Somalia.
Prepared by senior students:-                                       Tutor:-
1.Mohe’d Abdullahi Awale                           Dr:- Abdullqadir Mohe’d Hasan
2.Mohe’d Moh’ud Omar(Arab)                                  
3.Abdullahi Abdiaziz Farah.



Contents                                                                                     pages
  
 Introduction…………………………………………………………..1

 Health …………………………………………………………..........2

 Environment and socio-economic status in bulo marer village……...4

Traditional healers…………………………………………………….5

Subject and methods…………………………………………………..6

Table 1…………………………………………………………………7

Table 2…………………………………………………………………7

Table 3…………………………………………………………………7

Table 4………………………………………………………………….7

Table 5…………………………………………………………………..8

Table 6…………………………………………………………………..8

Table 7…………………………………………………………………..9

Table 8…………………………………………………………………..9

Results………………………………………………………………….10

Summary and acknowledgment ………………………………………11

Reference……………………………………………………………...12







Introduction


Health seeking behavior is different from community to community depending socio-economic, education and traditional believes.
In Bulo Marer over all level of literacy and education is low infrastructure (roads, public transport, water, electricity supplies etc.) is under-developed.
The population is growing fast where as gross national product is static or going down per head of population, health facilities in personal are low in rural areas where most poor people live.
Health needs become high, the existing political system of the country is disabling and volatile.
WHO and UNICEF are trying to do their best to cover health needs in kuntuwarie district to reach health for all but the steps to provide HFA is very low.
For the reasons mentioned above the people become disoriented seeking health care in different behavior.
In order to design and set national goals of health needs it’s needed to assess health seeking behavior of the community and the factors that influencing it, so the faculty of medicine and surgery of Benadir university applied this study in bulo mare area in kuntuwarie District, Lower Shabelle Region, Somalia
 
























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Health

 Is a state of complete physical, mental, and social wellbeing and not merely an absence of disease or infirmity.
Health is on one hand, a highly personal responsibility and on the other hand a major public concern. It thus involves the individual and the community.
Health is now recognized a fundamental human right, it’s essentially an individual responsibility.
Health can never be adequately protected by health services with out the active understanding and involvement of community whose health is at stake.
In bulo marer and surrounding area, the people are farmers and nomadic, they are busy in daily life.
A health can be influenced by many factors including: -
·   Economic process, which reduces morbidity and increases the life expectancy and improving the quality of life.
·   Education especially female Education,
·   Occupation, employment produces work and promotes health, because the employment shows higher incidence of ill health and death.
Other contributions to the health of population derive from systems outside the formal health care system, i.e. health related system (e.g. food, agriculture and Education).
The standard of living in bulo population is not good other side of level of Education, employment status, food, dress, housing and sanitation. The way people live is composed of cultural and behavioral patterns and life long per ional habits.
The people in kuntuwarie district seek curative in bulo marer where HAYAT HOSPITAL is located. Kuntuwarie district is not far from the HAYAT HOSPITAL; it’s about 20km distance.
Some are 7km apart and others are >20km away from the Bulo, this shows the rate of medical problems, which exist in this district.
Health care professionals which consist mainly in nursing personal, doctors, specialist and paramedical personnel such as pharmacist and laboratory assistants could not exist enough and the levels of care is not adequate which is Primary level, corresponds to the home and health care station where a sick person can expect initial contact, oral rehydration and treatment of fever and minor injuries are associated with this level. This type of care involves the family, community and Secondary level is when sick person comes in to contact with a health care professional. Tertiary level corresponds to the hospital; this is final link in the chain of care offered to patients.
The health facilities whether local or newly established will not be able to meet medical demand. The diseases which are mainly suffer the population are: - diseases transmitted by contact such as scabies and conjunctivitis, STD such as syphilis, vector-transmitted diseases such as malaria and schistosomiasis, diseases transmitted through fecal matter –diarrhea (amebiasis and giardia, hepatitis, typhoid fever, ascariasis) and diseases transmitted through air- acute respiratory infection, Tuberculosis, measles and whooping cough.
Experience has shown that in kuntuwarie district, certain communicable diseases have a
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particularly great impact such as measles, diarrheal diseases and acute respiratory infection and malaria. Others, which are less important, are cholera, typhus and schistosomiasis.

     Factors influencing the impact of Communicable Diseases in Kuntuwarie.
 
  The risk factors listed below are numerous and the way they interact varies from case to case.
1.presence of new pathogenic agent:-
  Population migration may introduce new pathogenic agents into the host region, usually it’s not a new pathogenic agent in the strict sense, but rather a different strain from the one normal found in that particular environment.
2.susceptibility of the population:-
 A population’s susceptibility is reflected at two levels; the population’s immunity, which is low in some degree and it’s a consequence of long continued exposure to a particular infections.
Individuals immunity, the group of individuals usually at risk are the children under the age of four or five another factors is malnutrition, malnourished children are particularly susceptible to infections.
3.Increased Transmission:
Several factors contribute to an increase in disease transmission particularly:
ü   Overcrowding-the concentration of a group of people in a restricted space presents an obvious risk of epidemics.
ü   Deterioration of hygienic condition-lack of water for basic hygiene, accumulation of waste which encourage the proliferation of disease vectors and the absence of sanitation measures are all factors that help increase the transmission of communicable diseases.
4.deterioration of health services:-
The deterioration of health services affects disease transmission at all levels. For example no active vaccination are given, vector-control programmes deteriorate and little or no care is provided for the sick.
                    Prevalence and seriousness of medical problems
Several factors contribute to the increased prevalence and seriousness of medical problems in kuntuwarie district. Prevalence is usually a function of nutritional status, environmental and the deterioration of preventive services. One of the main reasons for the potentially greater number of serious problems in kuntuwarie is that access to medical services is impaired by the lack of the education. The combination of prevalence and seriousness leads to high mortality, this idea can be formulated as fallows: -
Prevalence×seriousness/access to medical care = Mortality

 Thus, the high prevalence of medical problems, the large numbers of serious cases and the reduced access to health care services all help the particularly high mortality rates found in kuntuwarie.


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Environment and socio-economic status in bulo marer village

The term environment implies all the external factors, which surround man.
Environment includes not only the water, air, and soil that form our environment, but also the social and economic conditions under which we live.
Every country has it’s own environmental properties; in general Somalia is under tropical environment.
Bulo marer is one of the villages in kuntuwarie district, the land is classy and suitable for farming and husbandry, people are forced into crowded, un sanitary conditions which can lead to outbreak.
The season divide for the whole in to two:-
 Eight months of raining season, and 4 months dry season, the dry season whether is hot, and the land become dry, while the raining season is so cold and the land is wet that is suitable for farming and animal raring.
Malaria is common for all the year but increases in the raining season.
The populations are in poor housing condition, presence of animal reservoir and insect vector which a constant treat to man’s health.
Much of the ill health in Bulo marer is due to environment sanitation that is unsafe water, polluted soil and unhygienic, disposal of human excreta.
The high death rate, infant mortality rate, sickness rate and poor standards of health are infact largely due to defective environmental sanitation.
Most of the bulo marer populations live in rural areas and the problem is poor sanitation and waste disposal.
Any change occurs the environment will affect the social behavior and damages the sanitation of the population.
About 2/3 of the population use the channel water which is risk full for many diseases such as Bilharzias and diarrheal diseases.
The economical status of bulo marer divided in to two groups:-
Group depend on farming, which is majority, while the other group depend on commercial which is minority













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Traditional medicine
Traditional medicine is an old, as man exist, which is the anxious type of treatment that human being was using before the modern medicine were discovered.
It’s different the mode of applying from community to community, the traditional healers treat different type s of diseases in different manners.
The commonest ways of treating a sick person are: -
1)   Spiritual
2)   Herbal
3)   Others (burning, small cutting of special parts, etc.
If you think deeply and go back to the history of medicine, you will notice that it was successful to treat human being, for a long time until the modern medicine abrupt with it’s miracles, but yet traditional medicine it’s struggle in world wide not only to save it’s existing but to regain it’s superiority.
Now we would like to mention certain common diseases that are treated by traditional healers with traditional medicine.
Example of most common diseases of children and women   that are treated by the traditional healers in Bulo-Marer are: -
  Children
I.   dhajis:
Symptoms: abdominal pain, vomiting.
The cause: when some one hungry looks you while you are eating.
The treatment: the traditional healers makes small cut over the umbilical region and suck to get out the material that causes the ill health so the patient become fit as they believe.
II.   Ilkow:
Symptoms: diarrhea, vomiting.
The cause: canines
Treatment: they cut the position of canines to take out the roots of the canine, some times they burn, no matter what the age of the infant is.
III.   Ab Ab:
Symptoms: fever, restlessness, insomnia.
Treatment: mixed herbs they put on the head of infant.
Women
1.   umusibiyan  
Symptoms: pelvic, sterility.
Causes: a living thing lives in uterus (womb) of women that eats or sucks the sperm of the male with that reason; the women do not become pregnant.
Treatment: mix different types of seeds plant (filfil+ hulbo+tun+hildid + uburo +habit sowdo ), when the women use to treat orally for days which kills the living thing in the uterus.
2.   Rimi Rebka
During the pregnant, the labour becomes prolonged, so in order to facilitate they put HIRZ on her thigh.
N.B we have not any prove, whether these type of disease exist and treatment is successive.
-5-

Subjects and methods


Area of study
Bulo-Marer/ kuntuwarie District/Lower Shabelle /Somalia was used for the study.

Sample and sampling technique
1.   200 adults (100 male and 100 female) were chosen randomly in Bulo- Marer and it’s surrounding area by the researchers, direct contact with them, the criteria of selection was according to the area they live which was inside bulo marer, 100 persons (50 male+ 50 female), and outside bulo marer 100 persons (50 male +100 female).


Aim of the Research
To know behavior of the community of bulo and its surrounding area how they seek health and factors of the influencing this behavior.

 


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Offline dr-awale

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Re: Health seeking behaviorin Bulo-Marer community and surrounding villages
« Reply #1 on: January 18, 2009, 10:47:43 PM »
Research instrument
1.   Researchers: - senior students, in public health clerkship of faculty of medicine and surgery, Banadir University.
2.   Questionnaire: - consisting of 9 items and it’s content, dealt consist of  two section A(dealt with who and where they seek health care ), and B(factors influencing seek health care ), the questionnaire  consisted of 9 items which was content validated in the Banadir university.
The researchers completed the questionnaire, because the respondents have not formal educational base.


Data collection and statistical analysis
The researchers them selves administrated and collected data from the respondents, visiting public places (mainly males), and home visiting (mainly females) every day from 3/ march/ 2008 to 18/ march/ 2008 consecutive days to complete their number needed questionnaire.
The questionnaire was completed by the researcher, because the respondents were a illiterate.
The contents of the questionnaire were interpreted in percentile.






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Table 1. How old are you?

How old are               Male 100           Female100             Total 200    Sex ratio
   N   %   N   %   N   %   
<30yrs 31-40yrs  41-50yrs  >50yrs   36252217   1812.5118.5   4336165   21.51882.5   79613822   39.530.51911   1.125:1.341.56:2.251.37:14.25:1.25



Table 2. What is the highest level of education you have completed?

Level of education             Male 100          Female 100            Total 200   Sex ratio
   N   %   N   %   N   %   
No school Koranik school Elementary High school Collage Higher education Religious schools Literacy school   262725145102   1313.512.572.50.501   49232020105   24.511.510100.502.5   755045175207   37.52522.58.52.5103.5   1.625:3.061.68:1.561.56:1.127:15:01:10:02:1


Table 3. Do you currently have paid employment?
Employment            Male 100       Female 100         Total 200   Sex ratio
   N   %   N   %   N   %   
  Yes   No   6535   32.517.5   4753   23.526.5   11288   5644   2.03:1.461.09:1.65

Table 4. How far do you live from the nearest health clinic or hospital
Nearest hospital distance   Male 100   Female 100   Total 200   Sex ratio
   N   %   N   %   N   %   
0-10km  11-20km  21-30km   >30km   89524   44.52.512   95311   47.51.50.50.5   184835   9241.52.5   1.39:1.482.5:1.52:14:1
-7-

Table 5Where do you usually go if you are sick, or to treat a general health problem?

To treat general health problem          Male 100       Female 100          Total 200    Sex ratio
   N   %   N   %   N   %   
Sheik to read on you Koran Traditional healer (Burning)Private clinicPharmacyGovernment clinic or hospitalTraditional&homeopathic healerClinic run by a nongovernmental organization Other:(fish eating)   56282954---2   56282954---2   642433383344-   642433383344-   12052629233442   602631461.51721   1.75:21.75:1.51.8:2.061.68:1.180:30:340:42:0
           
                 





Table 6How often do you generally seek health care at a clinic or hospital.

How often do you generally seek health care at a clinic or hospital?   Male 100    Female 100   Total 200   Sex ratio
   N   %   N   %   N   %   
  Twice a year or more  Once per year   Less than once a year but at least twice in past 5 years.  Once in past 5 years  Never in past 5 years  Other:   512510527   25.512.552.513.5   3825712180   1912.53.5690   89501717207   44.5258.58.5103.5   1.59:1.181:12.5:1.751.25:31:97:0
               












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 Table 7 if you feel seek, do you go for help.

If you are sick, do you go for help      Male 100       Female 100         Total 200   Sex ratio
      N   N   %   N   %   
In the same day  After 1day After 2 day After 5 day After 7 day   2612341513   136177.56.5   2010183517   105917.58.5   4622525030   2311262515   1.62:1.251.5:1.252.12:1.121.87:4.31.62:2.12


Table8. What are the sources of information that you think can most effectively reach people like you with information on illnesses

Sources of information                 Male 100   Female 100        Total 200   Sex ratio
   N   %   N   %   N   %   
    Newspapers&magazines    Radio                                                                             TV     Billboards     Brochures, posters and other printed materials     Health workers     Family, friends, neighbors and colleagues     Religious leaders     Teachers    Other (please explain):                                                     Clan leader and microphone   7591834217111047   7591834217111047   4640124819201444   4640124819201444   111231959036312491   5.5610.54.52.5451815.51245.5   1.75:11.8:21:08:11.5:11.31:1.51.06:1.181.37:2.51.25:1.751.46:1.37








-9-
Results

The rate of health seeking practice in bulo marer and surrounding area was shown in the following table.
The majority of the participants was <30yrs, of these 21.5% was female and 18% was male.
The second class was 31-40 yrs which is about 30.5%, the level of education of these participants 37.5% they have not base of education specially the females which is 24.5%. for the employment out of 200 ,112 are employed which is about 56% mostly are males 32.5%.
About 92% said that the nearest hospital for them is about 0-10kms, usually about 60%, they are sick and have chosen to read quran on them selves by sheik, the second  choice was pharmacy and private clinics and the last choice was  traditional healers.
Here you are noticed the traditional healers have yet their own priority among the community with approximately equal ratio between males and female.
About 44.5% seek health care at clinic, twice or more a year and mostly about 26% of them came after 2 days of ill filling.
In order to reach health information effectively to the community the three most effectively sources are: -
                                        Radio 61%
                                          Microphone 45.5% and Health worker 45%
























-10-

Summary

The present study provides, the level and influencing factors of health seeking behavior of bulo mare and it’s surrounding community.
the majority of participants were under 40yrs, they believe 1st to treat them selves to read quran on them by sheik , this means religious believe is the highest influential factor for seeking health care, pharmacy and private hospital came 2nd position while traditional healers is the last. 
Gender, employment, hospital distance are less influential.
They often seek health care twice a year and ask help in the same way if they become seek.
The most effective source use to reach health information to the people are according to their priority respectively: radio, health worker and microphone.

 
Acknowledgements

Special thanks to Dr: Mohe’d Mohu’d Hasan, the acting dean of faculty of medicine of Benadir university and Dr: Tahlil Afrah, lecturer of community medicine for their assistance and support.
DR: Ali Shot for offering us typing and printing in his special office.
And the last we would thank for SAHAN NGO for their always encouragements.

 

Pictures of researchers


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