|BRIEF RESEARCH ARTICLE
|Year : 2013 | Volume
| Issue : 2 | Page : 113-116
Health seeking behavior of the mother for the special care new-born units discharged child: A comparative study
Gursimer Jeet1, Atul Sharma1, Tulika Goswami Mohanta2, Ajay Trakroo3
1 Ph.D. Scholar, School of Public Health, Department of Community Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
2 Associate Professor, Department of Community Medicine, Assam Medical College and Hospital, Dibrugarh, Assam, India
3 Health Specialist, United Nations Children's Fund, Chhattisgarh, India
|Date of Web Publication||15-Jul-2013|
Ph.D. Scholar, School of Public Health, Department of Community Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh - 160 012
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Establishment of special care new-born units (SCNU) in hospitals not only serves to provide the intensive care to sick neonates, but presents with opportunities to enhance knowledge and modify attitude and practices of their parents through behavior change communication (BCC). A cross-sectional study was conducted in Dibrugarh District, Assam from January to June, 2011 to assess differences in health-care seeking behavior of these mothers from mothers of newborns who were born at home and mothers who had normal uneventful institutional deliveries. Mothers of 29 SCNU discharged, 34 institutions delivered and 26 home delivered children were interviewed using a semi-structured interview schedule and a knowledge, attitude and practice (KAP) survey tool. Mothers of children admitted to SCNU scored better in questions related to vaccination, contraception, protection of child from infections and cold and perceptions about traditional healers, but overall KAP scores in the three groups were not found significantly different.
Keywords: Health seeking behavior, Knowledge attitude practice levels, Special care new-born units
|How to cite this article:|
Jeet G, Sharma A, Mohanta TG, Trakroo A. Health seeking behavior of the mother for the special care new-born units discharged child: A comparative study. Indian J Public Health 2013;57:113-6
|How to cite this URL:|
Jeet G, Sharma A, Mohanta TG, Trakroo A. Health seeking behavior of the mother for the special care new-born units discharged child: A comparative study. Indian J Public Health [serial online] 2013 [cited 2020 Apr 4];57:113-6. Available from: http://www.ijph.in/text.asp?2013/57/2/113/115007
Health seeking behavior of parents for the child is an important factor affecting child health. In terms of illness behavior, it refers to activities undertaken by individuals in response to symptom experience.  It is influenced by a large number of factors apart from knowledge and awareness,  operating at individual, family and community level, including the bio-social profile of individual, his past experiences, influences at the community level, availability of alternative health-care providers and his perceptions regarding efficiency and quality of the services available. Belief system prevalent in the communities, i.e., how people conceptualize the etiology of health problem and how symptoms are perceived is another important factor in deciding the first step of treatment seeking. 
As parents of newborns admitted to special care new-born unit (SCNU) at birth get exposed to health-care system for a prolonged phase, it presents a suitable opportunity to influence their thinking and modify their belief patterns in a positive manner. Health promotion activities undertaken with an earnest approach at this time can bring significant changes to child mortality. Keeping this in mind, this study attempted to examine the mother's health-seeking behavior in three different scenarios, in an attempt to find out the effect of child's stay in SCNU on mothers (in SCNU group) as compared to in cases where child was delivered, at home (in home delivery or HD group) or at an institute but did not need any special care (in normal institutional delivery or NID group). This was done by assessing differences in knowledge, attitude, practice (KAP) levels of mothers regarding child care and ascertaining differences in perception of parents about common childhood problems and resources available in the community for their solution.
The cross-sectional study was conducted in Dibrugarh District, Assam from January to June, 2011. Considering financial and logistical constraints, the sample of SCNU discharged children was limited to a single month. Thus, all neonates discharged from SCNU at Assam Medical College, Dibrugarh in the month of October 2010 and belonging to the district constituted this group. As children belonged to all seven blocks, the group constituted a fair representation of the whole district. For each SCNU group child, two children born in the same period and belonging to the same area were selected: A child born through NID was randomly selected from records at the peripheral health centers, while a home delivered child was found with the help of local auxiliary nurse-midwife (ANM) at the subcenters. Proximity to the health center was chosen as the sole criteria for selection of home delivered child, so that data remains unbiased in terms of all other socio-demographic variables, considering non-random nature of sampling for this group. A pre-tested semi structured interview schedule was used to question mothers of the infants. First part of the interview schedule dealt with exploration of health seeking behavior following Kroeger's model,  which recorded subjective responses. The second part had an objective KAP proforma to judge the knowledge, attitude of respondents regarding child care and practices followed by them. One mark was awarded for every correct response stated by the respondent, 0 for no response, whereas one mark was deducted for an incorrect response. The marks were totaled in the end to calculate net scores.
In total, data was collected from parents of 34 neonates in each group. Written informed consent was obtained from all participants. Data from 29 SCNU discharged, 34 institutions delivered and 26 home delivered cases were finally selected for analysis, others rejected due to minor errors. Data was entered and analyzed using Epi Info and Microsoft excel software programs. Chi-square test was used to compare various proportions while one-way ANOVA was used to compare mean monthly incomes and KAP scores in the three groups.
Majority of SCNU group children were found to be males (75.9%) as has been observed in studies conducted in other districts of India.  The difference between male and female children in this study was found to be statistically significant (P value = 0.0064). Since the north-east states of the country are not known for gender discrimination at birth,  this finding might not reflect differences in health seeking behavior of the mothers on the basis of gender, but be better explained in terms of lower survival capabilities of male neonates.
Around 69% of the cases from SCNU group were of first birth order, whereas in HD cases only 5 (19%) children were found to be first born in the family. Parity status for most of the HD group respondents was higher than that of respondents in the other two groups, where 19% of the mothers were pregnant for the 3 rd time. First time parents were thus more careful and sought institutional care during delivery, the tendency decreasing with increase in number of children.
Average monthly income of the SCNU group was higher (INR 6700.0) than the other two groups and it was lowest in HD group (INR 3223.0) and the differences in the means between three groups was statistically significant (P value = 0.05). Around 65.4% of the mothers in HD group were illiterate. In other two groups, the proportion of illiteracy was lower and almost equal, around 26-27%. Most of the mothers in all the three groups were housewives. Higher income levels and literacy thus seem to play a significant role in enabling people to access special care as has been reflected in other studies done on health seeking behavior, which accept that poor literacy, lack of awareness about services and poverty pushes health to a low priority.  Schellenberg et al., had also reported that there was an association between socio-economic status and health seeking behavior; with low socio-economic status people seeking frequently the public health-care  or no care at all.
When asked about the common childhood morbidities, the top two conditions enlisted by respondents in all three groups included fever (SCNU: 68.9%, NID: 55.8%, HD: 65.3%) and cough (SCNU: 79.3%, NID: 52.9%, HD: 65.3%). Other conditions mentioned were diarrhea, cold, malaria and jaundice. Though profile of the diseases remained similar in all the groups, mothers in SCNU group were most confident about their responses. 62% of the SCNU group respondents listed jaundice as compared with other two groups (NID: 0%, HD: 15%).
Development of fever or cough was the most common sign that most mothers in HD group (85%) and NID groups (59%) considered when deciding to take the child to the physician. SCNU group mothers gave maximum importance to sick appearance of child (48%) and difficulty in breastfeeding (45%). Other signs mentioned were loose stools, difficulty in breathing and yellow palms and soles.
The most common factors causing diseases as cited by parents were exposure to cold (SCNU: 34%, NID: 44%, HD: 54%) and unhygienic conditions (SCNU: 27.5%, NID: 18%, HD: 19%). Other causes listed were exposure to hot air, dietary deficiencies, changing weather and non-immunization. The HD group enlisted various "mother-related" causes also, such as excessive work by the mother, mother's insufficient diet and mother taking bath with cold water. Mother's ill health was reported by 23% of mothers in this group, whereas only 3% in SCNU group considered it important.
Most of the respondents selected government doctors (SCNU: 41%, NID: 35%, HD: 38%) and Tea-garden management run hospitals (SCNU: 38%, NID: 32%, HD: 35%) as their choice of preference for treatment of a sick child. Consultations from accredited social health activists (ASHA), ANMs, private doctors, traditional healers and self-medication were also observed. Mothers from rural areas were found to be consulting ASHA workers (11.3%) more often than ANMs (4.6%) for health related issues, while self-medication by parents was also observed in 14-15% cases in all groups. Use of alternative/informal health-care services was reported by mothers in HD and NID groups. They were found to go to traditional healers/shamans (a person who practices magic or sorcery for purposes of healing, divination and control of natural events) for folk medicines, at different timings and for different reasons during the course of sickness of their child. These reasons ranged from having a firm belief in the traditional systems, failure to heal from other therapies or for trying out multiple therapies in conjunction with each other. Surprisingly, no respondent in SCNU group mentioned going to traditional healer for treatment.
The NID group scored highest KAP score levels (12.3) as compared to other groups. Average KAP scores in the three groups were not found significantly different from each other (F-test statistic = 1.227, P value = 0.298). The HD group scored less than other two groups in knowledge (2.38) and attitude (2.23) scores, but in practices pertaining to child care, they scored close to the two other groups (HD = 4.5, NID = 4.5, SCNU = 3.5). This can be explained in two ways, either despite of their poor knowledge levels, the common child health related practices that are prevalent in the community are followed by them as part of culture; or the health workers in their areas concentrate on them more because of poor health indicators in this subset of mothers and children.
Questions for which maximum numbers of correct responses were obtained from SCNU group were related to vaccination, contraception, keeping child warm and free from infections. Statements for which significant differences in number of correct responses obtained from the three groups were observed have been shown in [Table 1].
|Table 1: Proportion of correct responses received from respondents in the three groups for selective questions in KAP proforma|
Click here to view
For questions judging attitudes, maximum correct responses were received from NID group respondents. The sole exception to this were questions pertaining to diarrhea management, which yielded very few correct answers from all the three groups (HD = 26.9%, NID = 20.5%, SCNU = 37.9%).
Exclusivity of breast feeding was most common for NID group (94.1%) whereas it was seen among 79% respondents in SCNU group. 12 (46.2%) of the HD group, 20 (58.8%) of the NID group and 15 (51.7%) of SCNU respondents claimed to have knowledge of vaccine preventable diseases, but very few could enlist them correctly.
Reading instructions given on neonatal/discharge card/ante-natal care card for benefit of mothers was found to be the least followed practice among all respondents (7.6% in HD, 11.7% in NID, 24.1% in SCNU group). Reasons cited for this behavior were illiteracy of the mother, language of instructions being English and unawareness regarding presence of these instructions on the card. Practices such as Kangaroo mother care and hand-washing before and after handling children were not being followed by respondents in any of the three groups.
Thus, though mothers of SCNU discharged children subjectively enlisted their perceived morbidities, danger signs for recognizing illnesses and predisposing factors behind these illnesses, more effectively than other two groups, lack of significant differences in KAP scores questioned the extent of improvement. However, a positive effect of stay of children in SCNU on their mother's health-care seeking behavior for the child can still be claimed, which can be improved further through better counseling at SCNU. Health literacy levels in general also need improvement as shown by KAP scores of the other groups. Since net practice scores were less than knowledge scores in two groups, this signifies lack of channels for behavior change or lack of motivation. Behavior change communication (BCC) activities related to birth planning and preparedness as well as correct recognition and treatment of common childhood diseases also need improvement.
As this study had a small sample size, further research needs to be conducted to strengthen the results. The study also could not document community influences and perceptions regarding efficiency and quality of the available services adequately due to financial and time constraints, which was an important limitation. As non-probability sampling was followed for neonates in home-delivery group, data were less amenable to further statistical tests, which was another important limitation of the study.
| References|| |
|1.||Tones K. Health promotion, health education and the public health. In: Detels R, McEwen J, Beaglehole R, Tanaka H, editors. Oxford Textbook of Public Health. 4 th ed. Delhi: Oxford University Press; 2002. p. 829-63. |
|2.||Jain M, Nandan D, Misra SK. Qualitative assessment of health seeking behaviour and perceptions regarding quality of health care services among rural community of district agra. Indian J Community Med 2006;31:140-4. |
|3.||Hausmann-Muela S, Ribera JM, Nyamongo I. Health Seeking Behaviour and Health System Response. Available from: http://www.dcp2.org/file/29/wp14.pdf. [Cited on 2011 May 24]. |
|4.||Facility based new-born care: Current situation and future directions. Report of the round table consultation. New Delhi: IIPH Delhi, UNICEF; 2010. |
|5.||Yadav RJ, Singh P. Immunisation of children and mothers in north-eastern states. Health Popul Perspect Issues 2004;27:185-93. |
|6.||USAID. Health policy initiative. Health seeking behaviour in rural Uttar Pradesh: Implications for HIV prevention, care and treatment. Available from: http://www.healthpolicyinitiative.com/Publications/Documents/961_1_UP_Health_Seeking_Behavior_and_HIV_Brief_FINAL_8_31_09_acc.pdf. [Cited on 2011 May 30]. |
|7.||Schellenberg JA, Victora CG, Mushi A, de Savigny D, Schellenberg D, Mshinda H, et al. Inequities among the very poor: Health care for children in rural southern Tanzania. Lancet 2003;361:561-6. |