Project – Health-Seeking Behaviour and Delayed Presentation for Non-Communicable Diseases among Market Traders

CHAPTER ONE

INTRODUCTION

1.1 Background of the Study

Non-communicable diseases (NCDs) have become one of the most significant public-health challenges of the twenty-first century. Unlike communicable diseases, NCDs are generally not transmitted from person to person and tend to develop over long periods. The major categories include cardiovascular diseases, cancers, chronic respiratory diseases and diabetes, while hypertension and other chronic conditions also constitute important components of the NCD burden. The World Health Organization (WHO, 2022) identifies NCDs as major causes of premature mortality globally, particularly in low- and middle-income countries where health systems frequently face limitations in prevention, screening, diagnosis and long-term management.

The increasing burden of NCDs has important implications for individuals, families and communities because these conditions frequently require continuous healthcare rather than one-time treatment. Hypertension, diabetes and cardiovascular diseases, for example, may remain asymptomatic for considerable periods before producing serious complications. Consequently, individuals may not perceive themselves as ill and may not consider it necessary to visit a health facility for screening or medical assessment. The WHO STEPwise approach to NCD surveillance recognises raised blood pressure, raised blood glucose, overweight and obesity, unhealthy diet, tobacco use, harmful alcohol use and physical inactivity among important NCD-related risk factors requiring systematic surveillance and intervention (WHO, 2024).

One of the important behavioural dimensions of NCD control is health-seeking behaviour. Health-seeking behaviour refers broadly to the decisions and actions individuals take when they perceive symptoms, health risks or a need for healthcare. It may include self-medication, seeking advice from family members or friends, consulting traditional or spiritual practitioners, purchasing medicines directly from pharmacies or patent medicine vendors, visiting primary healthcare facilities, attending hospitals, or delaying treatment altogether. These behaviours are influenced by socioeconomic status, education, cultural beliefs, perceived severity of symptoms, accessibility of health facilities, cost of treatment, previous healthcare experiences and competing demands on people’s time.

Health-seeking behaviour is particularly important in the context of NCDs because early detection and continuous management can reduce the likelihood of severe complications. WHO (2020) emphasises the need for health systems to strengthen the detection, treatment and long-term care of people living with NCDs. However, national capacity to respond to NCDs remains uneven, especially in settings where primary healthcare systems have limited resources.

Delayed presentation is one consequence of inappropriate or inadequate health-seeking behaviour. Delayed presentation occurs when an individual waits for an extended period after experiencing symptoms or developing a health concern before seeking appropriate medical attention. In the case of NCDs, delayed presentation can be particularly problematic because some diseases progress gradually and may cause significant organ damage before obvious symptoms develop. When individuals eventually arrive at a health facility, they may therefore present with advanced disease, complications or multiple health problems requiring more complex and expensive management.

Evidence from Nigeria demonstrates the seriousness of late presentation for chronic diseases. For example, Ulasi et al. (2016) reported that late presentation remained common among patients with chronic kidney disease in Nigeria. In their study, a large proportion of patients presented with advanced-stage disease, with hypertension and diabetes identified among important underlying conditions. Such evidence illustrates how delayed engagement with appropriate healthcare can result in individuals reaching health facilities only when disease has become severe.

Nigeria’s NCD burden must also be understood within the country’s broader epidemiological transition. Changes in dietary practices, urbanisation, sedentary lifestyles, population ageing, tobacco and alcohol use and other behavioural and environmental factors have contributed to the increasing importance of NCDs. Akinwale et al. (2013), in a study of an urban university community in Nigeria, found that more than one-quarter of respondents had already been diagnosed with at least one NCD, with hypertension and diabetes among the reported conditions. A high proportion also reported risk behaviours such as unhealthy diet and sedentary living. These findings demonstrate that NCD risks exist even within urban populations that may have relatively greater access to health information and services.

The challenge of NCDs in Nigeria is therefore not simply the existence of disease but also the extent to which individuals recognise risk, seek care and remain engaged with treatment. WHO’s report on the Nigerian health system’s response to NCDs emphasises the need for improved prevention, early detection and integrated management of NCDs. The report of the Joint United Nations High-Level Mission on NCDs and tuberculosis in Nigeria similarly highlighted the importance of strengthening the country’s capacity to respond to chronic diseases through appropriate health-system interventions (WHO & UN Inter-Agency Task Force, 2021).

Market traders constitute an important occupational group within Nigerian urban communities. Markets are major centres of economic activity and provide livelihoods for large numbers of people. Traders spend substantial portions of their daily lives in market environments, often working long hours and managing responsibilities related to purchasing, selling, customer relations, transportation and household economic needs. These occupational demands may influence their health-seeking behaviour because taking time away from business activities to attend a hospital or health centre can result in lost income.

The economic implications of seeking healthcare may therefore constitute an important barrier among market traders. An individual who depends on daily sales may consider a day away from the market costly, particularly where there is no employee or substitute worker to manage the business. As a result, minor symptoms may be ignored, treated with medicines purchased without professional consultation, or managed through home remedies until they become more severe. This possibility is especially concerning for NCDs because early symptoms may be mild or absent, thereby making delayed healthcare-seeking behaviour more likely.

The problem may be further complicated by the relatively asymptomatic nature of several NCDs. Hypertension, for instance, is frequently described as a condition that may remain undetected because many people do not experience noticeable symptoms. The WHO identifies regular blood-pressure measurement and appropriate management as important components of hypertension control. Where individuals rarely interact with health services, hypertension may therefore remain undiagnosed until complications such as stroke, heart disease or kidney problems occur.

Diabetes presents a similar challenge. Individuals may experience symptoms gradually and may attribute increased thirst, frequent urination, tiredness or changes in body weight to ordinary physical or occupational circumstances. Without screening or clinical evaluation, diagnosis may be delayed. The Nigerian context is particularly important because recent national evidence indicates substantial gaps in screening opportunities. Nwankwo et al. (2026), using nationally representative Nigerian survey data, found that blood-pressure screening was considerably more common than blood-sugar screening, illustrating missed opportunities for integrated detection of hypertension and diabetes.

Health-seeking behaviour among market traders may also be influenced by perceptions about the seriousness of symptoms. Individuals who interpret symptoms as temporary may wait for them to disappear. Others may rely on previous experiences, recommendations from friends, family members or fellow traders, or medications that appeared effective for similar symptoms in the past. Such practices can contribute to delayed presentation, particularly when symptoms are associated with chronic diseases that require professional diagnosis and long-term management.

The accessibility and organisation of healthcare services may also affect health-seeking behaviour. Although urban populations generally have greater physical proximity to health facilities than many rural communities, physical proximity does not automatically guarantee effective access. Cost, waiting time, opening hours, quality of services, availability of medicines and previous experiences with healthcare providers can determine whether an individual chooses formal healthcare. The WHO (2020) therefore stresses that effective NCD control requires health-system capacity for detection, treatment and continuing care rather than merely the physical existence of healthcare facilities.

Cultural beliefs and alternative sources of care may further influence the pathway through which individuals respond to illness. In many African settings, people may combine biomedical treatment with traditional, spiritual or informal forms of care. Such pluralistic health-seeking behaviour is not necessarily unique to NCDs, but it can contribute to delays when individuals move between different forms of care before obtaining appropriate medical assessment. The WHO’s NCD surveillance framework recognises the importance of understanding behavioural and social determinants alongside biological risk factors when developing appropriate responses.

Another important consideration is health knowledge. Possessing information about a disease does not necessarily mean that an individual will seek care promptly. A trader may know that hypertension or diabetes is dangerous but still postpone screening because of cost, work demands or the belief that the absence of symptoms means there is no immediate danger. Health literacy must therefore be considered together with economic, occupational and social circumstances.

The urban context of Onitsha South Local Government Area makes this issue particularly worthy of investigation. Onitsha is an important commercial centre in Anambra State, and market activities constitute a major part of the socioeconomic life of the area. Traders in selected markets are exposed to occupational demands that may compete with preventive health activities and routine medical consultations. The concentration of traders and customers in busy market environments also creates a unique setting in which health information, personal experiences and informal advice can circulate rapidly among members of the trading community.

Despite the growing body of literature on NCDs in Nigeria, there remains a need for research that specifically examines health-seeking behaviour and delayed presentation among market traders. Existing studies have addressed NCD prevalence, risk factors, healthcare utilisation and late presentation among various Nigerian populations, but the circumstances of market traders deserve focused attention. Their occupational dependence on daily commercial activities, financial considerations, working hours and exposure to informal sources of health information may produce patterns of healthcare behaviour that differ from those of other urban populations.

The present study therefore seeks to examine health-seeking behaviour and delayed presentation for NCDs among market traders in selected markets in Onitsha South Local Government Area, Anambra State. The study will pay attention to the types of NCDs known or reported among traders, responses to symptoms, sources of healthcare, factors influencing healthcare decisions, time taken before seeking formal medical attention and reasons for delayed presentation. Understanding these factors can provide useful evidence for developing health-promotion and early-detection interventions targeted at market communities.

1.2 Statement of the Problem

Non-communicable diseases constitute a growing public-health problem in Nigeria, yet their control depends substantially on early detection, appropriate treatment and continued engagement with healthcare services. The difficulty is that many NCDs develop gradually and may not produce obvious symptoms in their early stages. Consequently, individuals who feel generally well may have little motivation to undergo routine screening or seek professional medical advice. WHO (2022) identifies early detection and appropriate management as central elements in reducing the burden of NCD-related morbidity and mortality.

A major concern is that some individuals do not seek formal healthcare immediately after experiencing symptoms. They may first ignore the symptoms, use previously purchased drugs, consult friends and relatives, visit patent medicine vendors, use traditional remedies or seek spiritual intervention. While these approaches may sometimes provide temporary relief, they may also postpone professional diagnosis. In the context of chronic diseases, such delays can allow disease processes to continue without appropriate management.

The problem of delayed presentation is particularly important for hypertension and diabetes because both conditions may remain undiagnosed for long periods. A person may continue normal occupational activities while disease is silently progressing. By the time medical attention is sought, complications may have developed. Evidence from Nigeria concerning chronic kidney disease demonstrates how patients can present to tertiary healthcare facilities at advanced stages of disease, with hypertension and diabetes constituting important associated conditions (Ulasi et al., 2016).

Market traders may be especially vulnerable to delayed healthcare-seeking behaviour because their economic livelihood depends on daily commercial activity. Visiting a healthcare facility can require closing a shop or leaving a stall unattended, potentially resulting in lost sales. For traders operating with limited financial margins, healthcare expenditure may also be viewed as an additional economic burden. Consequently, a trader experiencing mild or moderate symptoms may continue working and postpone hospital attendance until the symptoms interfere substantially with normal activities.

Another problem is the possibility of self-medication. In a busy market environment, traders may have easy access to medicines through pharmacies, patent medicine vendors or informal recommendations from other traders. The availability of medicines can make self-treatment appear more convenient than visiting a healthcare facility. However, self-medication may mask symptoms without addressing the underlying disease and may contribute to inappropriate treatment or delayed diagnosis.

The problem is further complicated by inadequate routine screening. NCDs require sustained preventive and screening activities because many affected individuals may not know that they have the disease. The WHO STEPS framework specifically promotes systematic assessment of risk factors such as blood pressure, blood glucose, obesity, tobacco use, alcohol consumption, unhealthy diet and physical inactivity (WHO, 2024). When individuals rarely undergo health checks, opportunities for early identification can be missed.

Evidence from Nigeria also points to gaps between different types of screening. Nwankwo et al. (2026) found substantial missed opportunities for diabetes screening among Nigerians who had already undergone blood-pressure screening. Although their study was not specific to market traders, it illustrates the broader problem of incomplete detection of common NCDs within the Nigerian population.

There is therefore a need to understand the reasons why market traders may postpone seeking appropriate healthcare. These reasons may include lack of time, cost of treatment, perceived severity of symptoms, fear of diagnosis, poor knowledge of NCDs, previous negative healthcare experiences, reliance on self-medication, cultural beliefs, preference for alternative care and the economic consequences of leaving business activities. Without identifying the relative importance of these factors, health interventions may not effectively address the causes of delayed presentation.

The absence of sufficient local evidence concerning market traders in Onitsha South Local Government Area represents an important research gap. National and regional evidence provides useful information about NCDs and healthcare utilisation, but the findings may not adequately capture the occupational realities of traders in specific urban markets. Local research is necessary to determine how traders in the selected markets recognise illness, where they seek care, how long they wait before seeking formal medical attention and what factors influence these decisions.

The problem addressed by this study is therefore not merely the existence of NCDs among market traders but the possibility that inappropriate health-seeking behaviour and delayed presentation may prevent early diagnosis and effective management. If traders consistently postpone medical consultation until symptoms become severe, opportunities for prevention and early treatment may be lost. This may ultimately increase the risk of complications, healthcare expenditure, productivity losses and premature mortality.

It is against this background that the study will investigate Health-Seeking Behaviour and Delayed Presentation for Non-Communicable Diseases among Market Traders: A Study of Selected Markets in Onitsha South Local Government Area, Anambra State. The study is expected to generate empirical information that can assist public-health practitioners, healthcare providers, market associations and policymakers in designing interventions that promote early recognition, screening and appropriate healthcare utilisation among market traders.

1.3 Aim of the Study

The aim of this study is to examine health-seeking behaviour and delayed presentation for non-communicable diseases among market traders in selected markets in Onitsha South Local Government Area, Anambra State.

1.4 Objectives of the Study

The specific objectives are to:

1. assess the level of awareness of non-communicable diseases among market traders in selected markets in Onitsha South Local Government Area;
2. identify the common health-seeking behaviours adopted by market traders when experiencing symptoms associated with NCDs;
3. determine the extent of delayed presentation for suspected or diagnosed NCDs among the traders;
4. identify factors responsible for delayed presentation among market traders;
5. examine the relationship between health-seeking behaviour and delayed presentation for NCDs among market traders; and
6. determine the influence of socioeconomic and occupational factors on health-seeking behaviour among market traders.

1.5 Research Questions

The study will answer the following research questions:

1. What is the level of awareness of non-communicable diseases among market traders in selected markets in Onitsha South Local Government Area?
2. What health-seeking behaviours are commonly adopted by market traders when experiencing symptoms associated with NCDs?
3. To what extent do market traders delay presentation for suspected or diagnosed NCDs?
4. What factors are responsible for delayed presentation among market traders?
5. What relationship exists between health-seeking behaviour and delayed presentation for NCDs?
6. How do socioeconomic and occupational factors influence health-seeking behaviour among market traders?

1.6 Research Hypothesis

H₀: There is no significant relationship between health-seeking behaviour and delayed presentation for non-communicable diseases among market traders in selected markets in Onitsha South Local Government Area, Anambra State.

1.7 Significance of the Study

The study will be beneficial to market traders by increasing understanding of the importance of early recognition, screening and appropriate medical attention for NCDs. The findings may encourage traders to reconsider practices such as ignoring symptoms, prolonged self-medication and postponing medical consultations because of business activities.

Healthcare providers may also benefit from the findings. Information on barriers to healthcare utilisation can assist health workers in designing health-promotion programmes that are appropriate for market populations. Outreach screening programmes for blood pressure, blood glucose, obesity and other NCD risk factors could potentially be organised around market schedules to reduce occupational barriers to healthcare access.

Market associations and leaders may use the findings to promote health education among their members. They may support periodic medical screening exercises, health talks and referral arrangements that encourage traders to seek appropriate care promptly.

The findings may also be useful to public-health authorities and policymakers in Anambra State. Understanding the factors that contribute to delayed presentation may support the development of community-based NCD interventions targeted at occupational groups that may have difficulty accessing conventional healthcare services during working hours.

Academically, the study will contribute to the growing body of literature on NCDs, health-seeking behaviour and healthcare utilisation in Nigeria. It may provide a basis for further research involving other occupational groups and urban communities.

1.8 Scope of the Study

The study focuses on health-seeking behaviour and delayed presentation for NCDs among market traders in selected markets in Onitsha South Local Government Area, Anambra State. The study will examine awareness of NCDs, recognition of symptoms, healthcare-seeking choices, self-medication, use of formal healthcare facilities, alternative sources of care, perceived barriers to healthcare utilisation and factors contributing to delayed presentation. The study will concentrate on adult market traders in the selected markets and will not attempt to establish the clinical prevalence of every NCD in Onitsha South.

1.9 Operational Definition of Terms

Health-Seeking Behaviour: The actions and decisions taken by an individual in response to perceived illness, symptoms or health needs, including self-treatment, consultation with healthcare professionals and use of alternative sources of care.

Delayed Presentation: A situation in which an individual waits beyond an appropriate or reasonable period after recognising symptoms or a health problem before presenting to an appropriate healthcare facility for professional assessment.

Non-Communicable Diseases (NCDs): Chronic diseases that are generally not transmitted directly from one person to another, including cardiovascular diseases, diabetes, cancers and chronic respiratory diseases.

Market Traders: Individuals who engage in buying and selling goods or services as their principal commercial activity within the selected markets in Onitsha South Local Government Area.

Self-Medication: The use of medicines by an individual to treat perceived illness without appropriate diagnosis or direct prescription and supervision by a qualified healthcare professional.

Healthcare Utilisation: The extent to which individuals make use of available healthcare services for prevention, diagnosis, treatment and management of health conditions.

Health Awareness: The level of knowledge and understanding an individual possesses concerning diseases, symptoms, risk factors, prevention and treatment.

Early Presentation: Seeking appropriate professional healthcare relatively soon after recognising significant symptoms or health concerns, allowing timely assessment and intervention.

Selected Markets: The markets chosen by the researcher within Onitsha South Local Government Area for inclusion in the study.

1.10 Organisation of the Study

The study will be organised into five chapters. Chapter One presents the introduction, consisting of the background of the study, statement of the problem, aim and objectives, research questions, research hypothesis, significance, scope and operational definitions. Chapter Two will review relevant conceptual, theoretical and empirical literature relating to NCDs, health-seeking behaviour and delayed presentation. Chapter Three will present the research methodology, including research design, study population, sample size, sampling technique, instrument for data collection, validity, reliability and methods of data analysis. Chapter Four will present and analyse the data collected from respondents. Chapter Five will provide the summary of findings, conclusion and recommendations.

Project – Health-Seeking Behaviour and Delayed Presentation for Non-Communicable Diseases among Market Traders