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General Perception of Illness and Gender Differences in Health Seeking Behaviour amongst Kom People of Boyo Division in Cameroon during the COVID 19 Pandemic

Kenneth Yongabi Anchang*, Uwakwe Promise Chinedu, Bernadette Ateghang, Obasi Chidera

Department of Public Health, Faculty of Health Sciences, Imo State University, Owerri, Nigeria

Abstract: Background: Individual responses to health are influenced by an array of issues, ranging from personal traits, such as beliefs, to elements acquired through education and the socioeconomic environment. Individual responses to health became intensified during the COVID 19 pandemic in Cameroon. Health-seeking behavior is an important indicator of how health services are used and how they can modify the health outcomes of populations. This study aimed to evaluate the perception of illness and health-seeking behavior amongst the indigenous Kom people in Njinikom Sub Division, Cameroon within the COVID 19 pandemic era Cameroon to help facilitate this process of making health care choices within a brewing COVID 19 pandemic. Methods: A cross-sectional study was carried out by trained interviewers (five nurses), during which a total of 400 people (55.7% female) aged 18-60 years were chosen using multistage random sampling and interviewed after obtaining their informed consent. Data on the respondent's socio-demographic structures and patterns of illness and health-seeking behaviors in their last illness were collected using structured questionnaires. The study statistic used was Chi-square (X2), with a significant level (α) set at 0.05. Four components of community engagement were considered in the study, namely; (1) social support, (2) individual motivation, (3) service utilization, and (4) community acceptance. Results: The study revealed malaria as the most common disease (51%), followed by typhoid fever (21%). Results showed that women are more likely to seek health than males. The differences explained above were significant (X2 = 8.771, P = 0.003). A significant relationship was also observed between gender and health-seeking with an effect size of 0.148 (P = 0.003), as well as between level of education and health-seeking (X2 = 49.422, P < 0.001). There was no significant relationship between religion and health-seeking (X2 = 6.383, P = 0.076), as well as between occupation and health-seeking (X2 = 44.476, P < 0.001). Conclusion: Health-seeking behavior in Njinikom includes a high rate of self-medication and use of traditional medicine, due to the misconception of disease and the costs of health services. Even among respondents who prefer orthodox medicine, the principal reasons for its use were comparisons to traditional medicine, usually with a bad perceptional concept of it. Better health outcomes will be achieved if practical health literacy and promotional programs are developed that take into account the special needs of the community members and their living environment.

Keywords: health seeking, behaviour, perception of illness, community health, health promotion

Received June 17, 2021; Revised July 24, 2021; Accepted August 04, 2021

Citation: Kenneth Yongabi Anchang, Uwakwe Promise Chinedu, Bernadette Ateghang, Obasi Chidera, General Perception of Illness and Gender Differences in Health Seeking Behaviour amongst Kom People of Boyo Division in Cameroon during the COVID 19 Pandemic. American Journal of Public Health Research, 9 (5). 189-200. January 2021. doi:10.12691/ajphr-9-5-2

1. Introduction

The human health is affected by social determinants including but not limited to culture, socio-economic condition, demographics features, and politics, physical, chemical and biological environments [1]. These factors which become a crucial consideration when faced with pandemics such as COVID-19 may influence the individual health behavior, which can be defined as those personal attributes such as beliefs, expectations, motives, values, perceptions, and other cognitive elements; personality characteristics, including affective and emotional states and traits; and overt behavior patterns, action, and habits that relate to health maintenance, to health restoration and health improvement [2].

Some studies demonstrated that in many African countries, better education increases the chance of better health knowledge, to make more healthy choices, and supports access to health care services when ill [3,4,5]. But, the evidence suggest that in developing countries, the action of providing education and knowledge is not enough to promote important changes in health behavior, especially in an era of increased social media misinformation and misconceptions as witnessed in the COVID-19 era [6].

Because of that, the study of other useful indicators becomes necessary. In this context, the health seeking behavior becomes an important indicator of how the health services are used and how they can modify the health outcomes of populations [7,8]. For example, in Zimbawe and Nigeria, some studies reported the importance of removing obstacles like high costs or access to health care services in order to improve the health seeking behavior in pregnant women and children under five years [9,10].

Another study in the rural area in the Eastern Cape of South Africa evaluated the importance of the traditional practitioners as a valuable human resource and with a high influence in the health seeking behavior of mothers who had children under five years old with acute diarrhea [11]. Similarly in Uganda, other study mentioned that the increase access to health care with strategies like increasing of mobile clinic services or the integration of the community (with their cultural background) will be useful to improve of health-seeking behavior [7].

In Cameroon, a recent qualitative study brings out the need of governmental and non-governmental organizations to enhance people’s capacities and health policies to incorporate practices currently used and support pro-hygienic initiatives [12]. The aim of this study is, therefore, to evaluate the perception of illness and health seeking behavior in indigenous Kom people in Njinikom sub Division, Cameroon to help facilitate this process.

2. Materials and Methods

2.1. Study Area

The study was carried out in Njinikom sub division, Boyo Division in the North West Region of Cameroon in 2020. The Northwest Region (known before 2008 as the Northwest Province) is the third most populated province in Cameroon (Figure 1). It has one major metropolitan city. The province saw an increase in its population from approximately 1.2 million in 1987 to an estimated 1.8 million in 2010 The population density of 99.12 people per square kilometer is higher than the national average of 22.6. The provincial urban growth rate is 7.95%, higher than the national average of 5.6%, while the rural growth rate, at 1.16%, is equal to the national rate. In 2001, according to the Statistical Provincial Services of the North-West Province, the population of the province is young, with over 62% of its residents being less than 20 years old. Therefore, the dependency rate in the province is high, particularly in the rural areas. The Northwest Region has many ethnic groups, including immigrants from other regions and countries. Nigeria is well represented, as it borders the region to both the north and the northwest. The native population comprises a variety of ethnic and linguistic groups. The main ethnic groups are of Tikar origin. In the provinces, the social organization recognizes a chief as its head, also called the Fon. The Fons, who in their tribal area may be more influential than the official administrative authorities, are considered the living representative of the tribal ancestors. Njinikom is located 6°14′N 10°17′E.

The Kom language, Itaŋikom, is the language spoken by the Kom people of Cameroon.

2.2. Study Design

A cross-sectional study was carried out by trained interviewers (five nurses) for the period of 5 days between April to 2020 to April 2021 in Boyo division of North West Region, Cameroon. The area is mountainous and grassland fields and is inhabited mainly by the Kom speaking people. The Kom people are mainly farmers with few in civil service, trading, artisans and student. There are two faith-based hospitals: Bingo Baptist and Catholic hospital in Njinikom. These areas haven’t any Government hospital or pharmacy shops but they have numerous medicine retail shops and vendors.

Figure 1. Map of Cameroon showing the Study area

Data collection from this study was collected from respondents between April 2020 to April 2021. Surveys were carried out in the study area with in-depth interviews (IDIs) and focus group discussions (FGDs) also carried out. Using a semi structured interviews guides adapted from a rapid assessment method validated in a setting in Nigeria. Three different interview guides were developed from IDIs for all the various groups (Farmers, students, etc.).

A total of 400 people (females and males) aged 18-60 years were chosen using multistage random sampling. Kom is made up of three sub divisions namely, Fundong, Belo and Njinikom sub divisions. The Njinikom sub division was selected by balloting. Ten quarters in each sub division constituted a cluster. By simple random sampling, Wombong was selected. The survey commenced from the quarter head house (the local chief) after determining the direction to go by spinning a bottle. Because the list of the houses in the community could not be obtained, every other house was selected. In each of the selected house, two adults irrespective of the sex were randomly selected to be interviewed. All adults who were permanent resident within the cluster were eligible.

The data was collected using structured questionnaires (validated by a pilot study and an expert judgment process), which consisted of open and close-ended questions, to collect information on socio-demographic structures of the respondent as well patterns of illness and health seeking behaviors in their last illness. For instance; what makes the people go to the hospitals? Is it only when they take ill or that they have in their regular routine to go for a medical checkup when not ill; what guides their selection of health care? Where do they seek health care? The data was collected in the evening time in order to include adults who have gone out in the morning for various activities to return home.

Ethical clearance was obtained from Ethical Review authorization Ref.CBC/DHS-L/14/2080 while consent was obtained from the local chief and the community group leaders before the survey within the community. At each selected houses, informed consent was obtained from each respondent after explaining to him/her what the project is meant to address. All potential candidates responded to all questions.

Data was entered with Microsoft Excel ® software and results were analyzed using STATA v 13 ®.

3. Results

55.7% of respondents were females. The mean age was 33±10 years. 29.3% were students while 27.8% were civil servants. 54.2% attained at least secondary education and 32.5% attained tertiary education. The socio-demographic characteristics of the respondent are summarized in Table 1.

Table 1. Socio-demographic characteristics of respondents

While in Table 2 below, shows that the difference in health seeking attitude among men and those who do not really seek health was not really significant as seen from the standard deviation.

Table 2. Gender of respondents * Health Seeking Cross tabulation

The highest cause of morbidity referred by respondents in the last illness episode was malaria fever (51%); followed by typhoid fever with (21%). The other causes are summarized in Figure 2.

Figure 2. Percentage of presumptive last illness episode referred by respondents

While 204 (51%) of the respondents treated themselves in the last illness episode (80% used orthodox medicine and 20% traditional medicine), further 196 (46%) sought treatment in various places to get well. In this group, 40 (21%) sought treatment with a chemist and 33 (18%) in a pharmacy. Also, 41 (22%) got treatment in a government hospital and 33(18%) in a private hospital. 23 (12%) went to a church and 16(9%) to a traditional healer. The remaining 10 (3%) refers that they didn’t take any action but got well.

58% of the respondents have an average monthly income of less than 15, 000 frs. Of these, 31% have monthly income less than 15,000 frs. Only 6% of the respondents have average monthly income above 29,000 frs. Figure 3 shows the relation between average monthly income and place of treatment.

The most frequent reasons for choosing a place for a treatment are the distance from house, quality of drugs, quality of treatment and the quick attention. In the case of the traditional healers, the most frequent reason for choosing them is that they provided better cure than hospitals (Table 2). When we asked about the reasons for seeking treatment; 123 (30.7%) answered that it depends of the seriousness of symptoms; 109 (27.2%) referred that their self-treatment failed, 85 (21.3%) told that they are searching the best treatment and 83 (20.8%) people mentioned their illness were interfering with work.

Figure 3. Average monthly income and place of treatment in the last illness episode referred by participants

Figure 4 gives a graphical presentation of the link between gender and health seeking from which one can observe that more females seek health compared to males.

Figure 5 below shows that 26% of respondent seek health and have attended tertiary education, 24% seek health and have attended Secondary education and 6% seek health and have no formal education or have just primary school education. A majority of people who seek health have either tertiary of secondary education background.

Figure 6 depicts that more married people seek health. Also, there is no significant difference in the number of singles who seek health and those who do not seek health. More widows, divorced and separated respondents seek health compared to those who do not seek health.

Figure 4. Gender by Health Seeking Clustered Bar chart

Figure 5. Educational level by Health Seeking Clustered bar chart

Figure 6. Marital Status and health seeking clustered bar chart

In Table 3, suggest that self-medication was widespread, and generally distance played a role in choice of location of health care. The closer the health care facility to the potential health seeking patient, the more likely that it influences choice.

Table 3. Reasons why people choose a place of treatment for their referred last illness episode

From Table 4 below, more females are health seeking (68.2%) compared to males (53.7%). The table suggests that there is an adverse relationship between being male and seeking health (standardized residual of -1.4). Generally, 38% of respondents seek health and are female and only 23.8% of respondents seek health that are male. This implies that women are more likely to seek heath than male. The differences explained above, where significant;

Table 4. Chi-Square tests for Gender by health seeking

In Table 5, Independently of the type of treatment chosen by the patient, 196 (49%) would select the treatment with orthodox medicine and 110 (27.5%) would choose the traditional medicine. The reasons for preferring one or other treatment are summarized.

Table 5. Reasons for preferring the use of orthodox or traditional medicine

In Table 6 below, inferring from the symmetric measures above, the phi, Cramer’s V and contingency coefficient show that there is a significant relationship between gender and health seeking with an effect size of 0.148.

Table 6. Symmetric Measures for gender by Health seeking Crosstab

From Table 7 below, amongst the different levels of education sampled, respondents with tertiary education are more likely to seek health than any other category (80% and a standardized residual 3.8). Generally, as the level of education increases, so too does the likelihood of seeking health increase.

Table 7. Educational Level * Health Seeking Cross tabulation

In Table 8 below, the chi square tests of significance with the fisher’s Exact Test was used to very if there is a link between level of education and health seeking. The differences observed were significant the risk to reject the null hypothesis (there is no link between educational level and health seeking) while it is true is lower than 0.01%.

Table 8. The chi square test of independence for educational level and health seeking

From Table 9, the symmetric measure presented in Table 6 (Phi, Cramer’s V, Contingency Coefficient) all show that there is a strong positive relationship between educational level and health seeking. The more educated you become, the more conscious you become of your health.

Table 9. Symmetric Measures between Educational level and Health seeking

Table 10 presents that Christians are the most likely religion to seek health more than any other religion (62.5% and a standardized residual of 0.4). 56.3% of Muslims seek health, 35% of traditional religions people seek health and 50% of respondents who do not belong to a particular religion seek health. The most less likely religious group to seek health are the traditional religious people.

Table 10. Religion of respondents * Health Seeking Cross tabulation

In Table 11, The observed differences in health seeking between the different religious groups was not significant at This implies that there was no significant difference between the observed and expected frequencies in the distribution of health seeking respondents in the various categories of religion. We did not find enough evidence to conclude that knowing someone’s religions affiliation can permit us to determine whether he more likely to seek health or not. The risk to reject the null hypothesis while it is true is 7.6% which is higher than the level of significant of 5%.

Table 11. Chi-Square Tests of independence between religion and health seeking

The symmetric measures in Table 12 did not find any significant relationship between religion and health seeking.

Table 12. Symmetric measures between religion and health seeking

Table 13 presents the cross tabulation between occupation and health seeking. The table shows that farmers (83.8%), then petty traders (77.5%) are more likely to seek health than other occupational categories sampled. 66.7% of students as well as tailors and seamstresses seek health compared to just 44% of hair dressers and 34% of people from other occupational categories who seek health. Generally, 69.5% of respondents seek health as opposed to 30.5% of respondents that do not seek health.

Table 13. Occupation of respondents * Health Seeking Cross tabulation

From Table 14, the observed differences in seeking health between the different occupational categories was significant

The risk to reject the null hypothesis (There exists no link between occupation and health seeking) while it is true is lower than 0.01%.

Table 14. Chi square test of independence between occupation and health seeking

In Table 15, the symmetric measure presented in Table 9 (Phi, Cramer’s V, Contingency Coefficient) all show that there is a positive and significant relationship between occupation and health seeking.

Table 15. Symmetric measures of occupation and health seeking

From Figure 7, shows that more farmers seek compared to other occupations. 23% of respondents were farmers and seek health, 20% are students and seek health and 17% are petty traders and seek health. More farmers seek health more than any other occupation.

Figure 7. Occupation influences health seeking

Figure 8 shows that a greater majority of respondents are Christians and are health seeking (56%). More traditional doctors do not seek health (3% of the total population).

Figure 8. Religion by health seeking clustered bar chart

4. Discussion

This study found 51% to perform self- medication and the most frequent reasons for that were the perception of disease (“a minor illness”) and costs of health services. This is similar to study of Klein et al [13] (50%) and Begashaw et al [14] (43%). The reasons which the respondents in our sample gave us are consistent to previous studies about the less accessibility to health facilities and unlicensed drug sellers [15].

The economic status was one factor studied. 31% of the respondents earned on the average less than 15,000 frs monthly and only 6% of them earned above 29,000 frs. In view of the cost of living in Cameroon, 15,000 frs per month is inadequate [16]. So, poverty could be a factor that influence and determine illness and health seeking behavior considering that 25% did self-treatment because they could not afford cost of treatment; and, among those that sought treatment, 70% did not use hospital treatment. In case of women and child health, the relation between poverty and health status or health seeking behavior had been well established [12,17] but we recommend making more studies about the inequalities in the distribution of health resources [18], which in relation to health seeking behavior must be investigated with an special emphasis in rural places like Njinikom.

The sub-estimation of the disease’s real magnitude can perhaps be explained by the association to the health literacy of the people investigated. Health literacy seems to be independent of educational status. In our study 98% of the respondents have had some form of education. Educational status is an indicator of socio-economic development of the country, it also determine factors such as reproductive behavior, use of contraceptive, infant mortality, proper hygienic habits, utilization of health services which are necessary to achieve healthy status. Hence, the educational level usually is related to the health-seeking behavior [5,19].

About the behavioral patterns, 70% of the respondents did not utilize hospital for treatment. Various reasons were given for the use of alternative centers. For those who utilize chemist and pharmacy their reasons include; closeness to them, low cost of treatment, quick attention and that they can also provide same treatment as doctors. Traditional herbal treatment is said to be as good as hospital treatment among those who used that option. All these information are consistent with Makoge et al [12], who finds a very similar dynamics of health-seeking behaviour in a qualitative study.

In this context, the use of traditional medicine has been considered more effective than orthodox medicine in 27% of respondents. In Cameroon, the traditional medicine practice have been considered a priority in integration of health system, because is socially and culturally accepted [20]. These practices have to be respected when traditional healers are making them under appropriate circumstances and contexts. In our study, people’s reasons for preferring the use of traditional medicine are their efficacy and practicality. These are perceived similar to orthodox medicine; which are in turn consistent to the idea of the traditional doctors being agents, who help to reconnect the social and emotional equilibrium of patients based on community rules and relationships [21].

However, we must to take into consideration that the most frequent cause of morbidity in respondents was malaria (70%), similar to other community health surveys. Because of this finding it is very important to improve the medical seeking behavior in the people, especially in rural areas such as Njinikom, where preventive public-health measures and health education on malaria should be more regular in order to prevent misconception in people and undesirable health seeking behavior [22,23].

The limitations of this study include the methodological design (a cross-sectional study) and the method of sample selection. Therefore, these results were not possible to be inferenced in all populations, nonetheless, this study is a valuable source of information in terms of the health seeking behavior patterns found among the Njinikom people in Cambodia.

5. Conclusion

In summary, the health seeking behavior in Njinikom includes a high rate of self-medication and use of traditional medicine. The principal reasons for self-medication were the misconception of disease and the costs of health services. The traditional medicine was considered effective and cheaper than the orthodox medicine, but among respondents who prefer orthodox medicine, the principal reasons for its use were comparisons to traditional medicine, usually with a bad perceptional concept of it. Furthermore, the study illustrates how malaria as the most common disease is under-treated. It is recommended to use the study results to build practical health literacy and promotional programmes that take into account the special needs of the Njinikom people and their life world in order to facilitate and strengthen better health outcomes among them.

Ethics Approval and Consent to Participate

Ethical clearance was obtained from Ethical Review authorization Ref. CBC/DHS-L/14/2080 while consent was obtained from the local chief and the community group leaders before the survey within the community. At each selected house, informed consent was obtained from each respondent after explaining to him/her what the project is meant to address. All potential candidates responded to all questions.

Consent for Publication

Participants were made aware in the consent form that the results of the study would be published but that no data would be presented to allow the identification of individuals.

Availability of Data and Materials

The dataset supporting the conclusions of this article are available with the authors, upon request.

Competing Interests

The authors declare that they have no conflict of interests.

Funding

This project was entirely supported by the PRF Research Foundation, Cameroon

Authors’ Contributions

KAYongabi supervised the data collection, analyzed the data and prepares the manuscript. KAYongabi and coauthors critically edited the manuscript. All authors read and approved the final manuscript.

Acknowledgements

The authors express profound gratitude to Phytobiotechnology Research Foundation (PRF), Cameroon for facilitating this study.

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