Project – Health seeking behaviour of malaria among pregnant women

CHAPTER ONE

INTRODUCTION

• Background to the Study

Malaria remains a significant public health threat in many parts of the world, particularly in sub-Saharan Africa, where pregnant women are at heightened risk due to physiological changes that make them more susceptible to infection and adverse outcomes. Pregnant women are more vulnerable to severe malaria, which can lead to maternal anemia, miscarriage, low birth weight, and even death (Kante et al., 2020). Malaria in pregnancy is also associated with increased risks of fetal mortality and developmental delays. Given these risks, effective health-seeking behaviors (HSBs) are crucial for early diagnosis, timely treatment, and prevention of malaria. However, the health-seeking behaviors of pregnant women toward malaria prevention and treatment vary across different cultural, economic, and healthcare settings (Adeleke et al., 2021).

Health-seeking behavior is broadly defined as the actions individuals take to prevent, recognize, and treat illness. For pregnant women, this encompasses practices like attending antenatal care (ANC) visits, taking antimalarial prophylaxis, using insecticide-treated bed nets (ITNs), and seeking medical attention when symptoms of malaria occur. Studies have shown that health-seeking behaviors are influenced by multiple factors, including socio-economic status, education, access to healthcare, cultural beliefs, and knowledge of malaria prevention and symptoms. In rural settings, where healthcare access may be limited, pregnant women often rely on traditional remedies or community health workers, which may not always be effective in preventing or treating malaria (Mlambo et al., 2019).

The role of antenatal care in promoting health-seeking behavior for malaria prevention is well documented. WHO guidelines recommend routine malaria screening and prophylaxis during antenatal visits in malaria-endemic regions (World Health Organization [WHO], 2023). However, studies indicate that despite the availability of ANC services, not all pregnant women attend these visits, and those who do may not adhere to malaria prevention guidelines. For instance, in a study conducted in Nigeria, less than 50% of pregnant women used ITNs regularly, and only 30% took the prescribed intermittent preventive treatment for malaria (IPTp) (Oduwole et al., 2022). Barriers such as long distances to healthcare facilities, inadequate health education, and misconceptions about malaria prevention were identified as significant factors influencing the uptake of malaria prevention strategies.

In addition to healthcare access, pregnant women’s health-seeking behaviors are shaped by socio-cultural factors. Research from Ghana and Kenya suggests that traditional beliefs, including reliance on herbal medicines and local healers, significantly affect women’s decisions to seek formal healthcare for malaria (Tolo et al., 2021). In some cases, women may perceive modern healthcare treatments as unnecessary or ineffective due to cultural beliefs about the causes and cures of malaria. Moreover, fear of side effects from antimalarial drugs, especially during pregnancy, has been identified as a deterrent to seeking formal treatment (Kante et al., 2020). In these contexts, improving health literacy and community education on the dangers of malaria during pregnancy and the importance of formal healthcare could enhance health-seeking behaviors.

Economic factors also play a critical role in shaping health-seeking behavior among pregnant women. Poverty, low income, and lack of transportation can prevent women from accessing healthcare services, including ANC visits and malaria treatment (Adeleke et al., 2021). A study in Malawi found that even when ANC services were available, high transport costs to reach health facilities and the indirect costs of treatment were significant barriers to care (Chikozho et al., 2020). In many low-resource settings, women may prioritize the treatment of other illnesses or family members over their own health due to limited financial resources. These economic constraints highlight the need for more affordable and accessible healthcare services for pregnant women in malaria-endemic areas.

A comprehensive approach to improving health-seeking behavior for malaria among pregnant women requires addressing these multifaceted challenges. Health interventions should not only focus on improving access to formal healthcare services but also consider socio-cultural, economic, and educational factors. Community-based interventions, such as health promotion campaigns, training of community health workers, and provision of free or subsidized malaria prevention tools, can improve health-seeking behaviors. Additionally, collaboration between healthcare providers, local leaders, and policymakers is essential to creating an enabling environment for pregnant women to adopt effective malaria prevention and treatment practices (Adeleke et al., 2021; Mlambo et al., 2019).

1.2. Statement of the Problem

Malaria remains one of the leading causes of morbidity and mortality in tropical and subtropical regions, particularly affecting pregnant women and their unborn children. Pregnant women are more vulnerable to malaria due to physiological changes in pregnancy that suppress the immune system, making it harder for them to fight off infections. Malaria during pregnancy is associated with severe complications such as anemia, low birth weight, preterm delivery, and even maternal and fetal death. Despite the availability of preventive measures, including insecticide-treated nets (ITNs), intermittent preventive treatment (IPT), and timely diagnosis and treatment of the disease, the health-seeking behavior of pregnant women remains a significant factor influencing the success of malaria control programs. Understanding the health-seeking behavior of pregnant women is essential to addressing gaps in malaria prevention and treatment efforts.

Health-seeking behavior refers to the actions individuals take when they perceive themselves to be ill, and it is influenced by a variety of factors, including socio-economic status, cultural beliefs, health education, and access to healthcare services. In the context of malaria, the health-seeking behavior of pregnant women is complex and often shaped by a variety of barriers. These can include a lack of knowledge about the risks of malaria during pregnancy, limited access to healthcare services, financial constraints, and cultural norms that may affect decision-making regarding healthcare. In many malaria-endemic regions, pregnant women may delay seeking medical care or rely on traditional medicine rather than accessing formal healthcare services, which can lead to delays in diagnosis and treatment, exacerbating the risks associated with malaria.

While some preventive measures, such as the use of insecticide-treated nets and the administration of IPT, have been widely promoted in malaria-endemic regions, their uptake and effectiveness often depend on the health-seeking behavior of pregnant women. Studies have shown that even when health interventions are available, they may not always be fully utilized due to misconceptions about malaria, fear of side effects from medications, or a lack of awareness about the importance of early treatment. Furthermore, many pregnant women may not recognize the symptoms of malaria, which can often be mistaken for other common illnesses, leading to delayed diagnosis and treatment. This delay can contribute to an increased risk of complications for both the mother and the child.

Another significant issue affecting the health-seeking behavior of pregnant women is access to healthcare facilities and services. In many rural and remote areas, healthcare infrastructure may be inadequate, with long distances to the nearest health facility, shortages of trained healthcare providers, or limited availability of antimalarial drugs. These factors can deter pregnant women from seeking timely care. Additionally, financial constraints may prevent women from paying for transportation, consultations, or medications, leading them to rely on self-medication or traditional healers. Even where health services are available, the quality of care may be inconsistent, further discouraging pregnant women from seeking medical attention when needed.

Cultural and societal factors also play a critical role in shaping the health-seeking behavior of pregnant women. In some communities, traditional beliefs and practices may influence decisions regarding the treatment of malaria. Pregnant women may prioritize traditional remedies over modern medical treatment due to cultural trust in local healing practices or fear of perceived side effects from conventional drugs. In some cases, pregnant women may also face social pressures from family members or community leaders, which can either encourage or discourage the use of formal healthcare services. Understanding the cultural context and the role of family and community dynamics is essential to promoting effective health-seeking behavior in malaria prevention and treatment.

Addressing the health-seeking behavior of pregnant women in the context of malaria requires a multifaceted approach that takes into account the various barriers and facilitators influencing their decisions. Interventions should focus on improving awareness about the risks of malaria during pregnancy, enhancing access to healthcare services, and addressing cultural barriers that may limit the use of preventive measures and treatment. Community-based health education campaigns, improving healthcare infrastructure, and ensuring the availability of affordable and accessible malaria prevention and treatment services are essential components of a comprehensive strategy to reduce the burden of malaria among pregnant women. By improving health-seeking behaviors, it is possible to mitigate the impact of malaria on maternal and child health, ultimately contributing to the broader goals of malaria control and elimination.

1.3. Aim and Objectives of the Study

The aim of the study is to examine the health seeking behaviour of malaria among pregnant women. The specific objectives are:

1. To assess the knowledge of pregnant women regarding malaria symptoms and prevention methods.
2. To identify the factors influencing pregnant women’s decision-making process in seeking healthcare for malaria.
3. To determine the accessibility and availability of healthcare services for pregnant women with malaria.
4. To examine the impact of socio-economic factors on the health-seeking behavior of pregnant women with malaria.

1.4. Research Questions

The research questions are buttressed below:

1. What is the level of knowledge among pregnant women regarding malaria symptoms and prevention methods?
2. What factors influence pregnant women’s decision-making process in seeking healthcare for malaria?
3. How accessible and available are healthcare services for pregnant women with malaria?
4. What is the impact of socio-economic factors on the health-seeking behavior of pregnant women with malaria?

1.5. Research Hypothesis

The hypothetical statement of the study is buttressed below:

Ho: Accessibility and availability of healthcare services have no significant effect on pregnant women with malaria

H1: Accessibility and availability of healthcare services have significant effect on pregnant women with malaria

1.6. Significance of the Study

Malaria is one of the leading causes of morbidity and mortality worldwide, particularly in sub-Saharan Africa where pregnant women are especially vulnerable. The significance of this study lies in its focus on understanding the health-seeking behavior of pregnant women in relation to malaria, as this group is at heightened risk due to physiological changes during pregnancy. Malaria in pregnant women can lead to adverse outcomes such as anemia, low birth weight, stillbirth, and maternal death, making it crucial to explore how women seek care for malaria symptoms, whether they access the necessary treatment, and the factors influencing their decisions. This understanding can directly inform public health strategies aimed at reducing the incidence and consequences of malaria among pregnant women.

Exploring the health-seeking behavior of pregnant women with malaria can provide insights into the barriers that prevent timely and effective care. In many malaria-endemic regions, despite the availability of preventive measures like insecticide-treated nets (ITNs) and antimalarial drugs, many pregnant women still fail to seek medical attention when they experience symptoms. These barriers can be multifaceted, including cultural beliefs, economic constraints, lack of access to healthcare facilities, and limited knowledge about the dangers of malaria during pregnancy. By identifying these barriers, health systems can be strengthened, and targeted interventions can be designed to promote better utilization of health services and reduce the burden of malaria in pregnancy.

Additionally, understanding health-seeking behavior can help identify gaps in healthcare delivery and potential areas for improvement. This study can highlight how the quality and accessibility of healthcare services influence the choices pregnant women make when they experience malaria symptoms. For instance, if healthcare services are too far away, too expensive, or perceived as ineffective, women may choose alternative sources of care, such as traditional medicine or self-treatment, which may not provide the necessary therapeutic benefits. In this regard, the study can contribute to improving health infrastructure, ensuring that health facilities are both accessible and equipped to handle malaria cases during pregnancy.

The findings of this study could also inform educational and awareness campaigns aimed at pregnant women, their families, and communities. Many women may not fully understand the risks associated with malaria in pregnancy, and this lack of knowledge can lead to delays in seeking appropriate care. By understanding the level of awareness and misconceptions about malaria, policymakers and healthcare providers can develop targeted interventions to educate pregnant women about the importance of early diagnosis and treatment, as well as the use of preventive measures. In turn, this can reduce the incidence of severe malaria and improve maternal and fetal outcomes.

Furthermore, this study’s significance extends to addressing social determinants of health that affect pregnant women’s decisions to seek care for malaria. Social factors such as income, education, and social support networks play a critical role in shaping health-seeking behavior. By examining how these factors intersect with malaria prevention and treatment practices, the study can provide valuable insights into the broader social context in which health decisions are made. This is particularly important for addressing health inequities in marginalized communities, where pregnant women may face compounded challenges in accessing proper healthcare.

Finally, this research can have a broader impact on the global fight against malaria, especially in areas where the disease remains endemic. By shedding light on the specific health-seeking behaviors of pregnant women, the study can contribute to the design of more effective malaria control programs. These programs can incorporate both biomedical and socio-cultural factors to improve health outcomes for pregnant women. In turn, this would contribute to achieving global health goals such as the reduction of maternal mortality and the elimination of malaria as a public health threat, ultimately improving the quality of life for pregnant women and their families.

1.7. Scope of the Study

The study examines the health seeking behaviour of malaria among pregnant women. The study is limited to Pregnant women attending Mother and Child Centre, Mushin, Lagos.

 

1.8. Operational Definition of Terms

1. Health-Seeking Behavior: Health-seeking behavior refers to the actions and decisions individuals or groups take to recognize, interpret, and respond to health problems. It includes seeking professional medical care, using self-care remedies, consulting traditional healers, or adopting preventive health measures. The behavior is influenced by various factors such as personal beliefs, socioeconomic status, access to healthcare, cultural norms, and health literacy. In the context of malaria among pregnant women, health-seeking behavior would involve how pregnant women respond to symptoms of malaria and whether they seek appropriate medical care.
2. Malaria: Malaria is a life-threatening infectious disease caused by thePlasmodium parasite, transmitted through the bites of infected female Anopheles mosquitoes. It is characterized by symptoms such as fever, chills, fatigue, headaches, and in severe cases, organ failure or death. Malaria remains a major public health issue in tropical and subtropical regions, especially in sub-Saharan Africa, where pregnant women are particularly vulnerable. Malaria during pregnancy can result in complications like maternal anemia, low birth weight, preterm birth, stillbirth, and increased maternal mortality.
3. Pregnant Women: Pregnant women are women who are carrying a developing fetus inside their womb. Pregnancy typically lasts around 40 weeks from the first day of the last menstrual period and is divided into three trimesters. Pregnant women have specific health needs and are at risk for various complications, including infections like malaria, due to the physiological changes that occur during pregnancy. Pregnancy can increase the severity of certain diseases, such as malaria, making it essential for pregnant women to receive adequate healthcare and preventive measures.
4. Mother and Child Centre: A Mother and Child Centre is a healthcare facility or program designed to provide specialized medical care and services to mothers, pregnant women, and children. These centers focus on maternal and child health by offering prenatal care, childbirth services, postnatal care, immunizations for infants, nutrition counseling, and treatment of diseases such as malaria. They aim to reduce maternal and child morbidity and mortality through comprehensive care, education, and support tailored to the needs of mothers and their children.
5. Treatment: Treatment refers to the medical management of a health condition through therapeutic interventions aimed at alleviating symptoms, curing the disease, or improving the overall health of the patient. For malaria, treatment usually involves the use of antimalarial drugs such as artemisinin-based combination therapies (ACTs) to kill the malaria parasites in the bloodstream. Treatment may also include supportive care such as fluids, pain relief, and the management of complications. In the case of pregnant women with malaria, treatment needs to be carefully chosen to avoid any harm to both the mother and the fetus.
6. Knowledge: Knowledge refers to the information, awareness, and understanding that individuals or communities have about a particular topic or issue. In the context of malaria, knowledge would include understanding the causes, symptoms, prevention methods (such as the use of insecticide-treated nets), and available treatments for the disease. For pregnant women, knowledge about the risks associated with malaria during pregnancy and the importance of early diagnosis and treatment is critical to making informed health decisions. Knowledge is often shaped by education, cultural beliefs, media exposure, and healthcare outreach programs.

Project – Health seeking behaviour of malaria among pregnant women