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  • Title: The use and non-use of preventive health services in a southern African village.
    Author: Ulin PR, Ulin RO.
    Journal: Int J Health Educ; 1981; 24(1):45-53. PubMed ID: 7293491.
    Abstract:
    This study investigates the relationship between the health beliefs of mothers in a Botswana village and their utilization of available maternal and child health resources, specifically immunizations, antenatal care, and clinic delivery. The two-pronged methodology includes (1) a household survey of 620 mothers of children under the age of five and (2) a series of intensive but informal, loosely structured interviews with 19 village women. Results show that a majority of the children had received one immunization but that few had ever had more. Most of their mothers had attended the antenatal clinic, but fewer than 30% had made use of the village maternity service in childbirth. As predictors of these kinds of preventive behaviour, mother's age, education, use of the radio, participation in voluntary women's organizations, and material consumption were, for the most part, unimpressive. On the other hand, qualitative data from the survey and intensive interviews revealed that women were confused between curative and preventive health measures. Few respondents linked immunization with prevention of specific diseases; half the women expressed concern that the immunizations were dangerous, while others indicated lack of knowledge about the desired number; still others believed that immunizations "made the children grow". As for maternity services, the majority of women who attended the antenatal clinic had actually done so for a somatic complaint. They were responding to their perception of the clinic as a place that cures, rather than prevents, illness. This was consistent with the finding that few used the clinic delivery service: most women saw no reason to seek professional help in the absence of perceived problems. The authors point out implications of this study for community-centred, in contrast to disease-centred, health education. The use of preventive health resources by mothers of young children in a rural village in southeastern Botswana were examined. It is in part a report of the extent to which these women frequent a village maternity clinic and permit their children to be immunized. The primary objective was to investigate the subjective meaning of these data in terms of cultural beliefs and understandings which influence the mothers' help-seeking behavior and the implication of these findings for health education. The larger investigation combined household survey and intensive interview techniques with 620 women, or about 90% of the female caretakers of children under 5 in Thamaga. Following the survey, 19 village women, purposively selected to represent a range of ages, education, and economic status were interviewed in depth. Most children under 5 years of age (69.9%) had had at least 1 immunization, but few (18.6%) had more. Most women (86.4%) had sought antenatal care in pregnancy, but many fewer (30.7%) chose to deliver in the clinic's maternity ward. 47% of the responses indicated a belief in the health benefits of immunization, but the remainder viewed them as potentially dangerous. The most common explanation for a distrust of immunization was the mother's observation of fever, malaise, and a skin eruption that followed innoculation. Many agreed reluctantly to immunization because the village headman had told the people to cooperate with health officials. Women who held a negative opinion of immunization had fewer immunized children. There were few children among the mothers who felt positively about immunization who had been immunized more than once. The explanation that emerged was that these women had no idea of the desirable number of immunizations for optimal protection. The findings regarding utilization of preventive maternity services showed a similar pattern which again suggested a misunderstanding of preventive health. Study results indicate a need for culturally more relevant health education and increased involvement of the people in the protection of their own health.
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