Health beliefs and (timely) use of facility-based care for under-five children: lessons from the qualitative component of Nigeria's 2019 VASA

Health beliefs and (timely) use of facility-based care for under-five children: lessons from the qualitative component of Nigeria's 2019 VASA

Nigeria's under-five health outcomes have improved over the years, but the mortality rates remain unacceptably high. The qualitative component of Nigeria's 2019 verbal and social autopsy (VASA) showed that caregivers' health beliefs about causes of illnesses and efficacious treatment...

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Published in:BMC public health Vol. 22; no. 1; p. 850
Main Authors: Kunnuji, Michael, Wammanda, Robinson Daniel, Ojogun, Tellson Osifo, Quinley, John, Oguche, Stephen, Odejimi, Adeyinka, Weiss, William, Abba, Bintu Ibrahim, King, Rebekah, Franca-Koh, Ana
Format: Journal Article
Language:English
Published: England BioMed Central 28-04-2022
BMC
Subjects:
Autopsies
Autopsy
Births
Caregivers
Child
Children
Children & youth
Childrens health
Community
Decision making
Fatalities
Health care
Health care facilities
Health Facilities
Health services
Health Services Accessibility
Humans
Illnesses
Interviews
Maternal & child health
Medicine
Midwifery
Mortality
Nigeria
Patient Acceptance of Health Care
Prenatal care
Public health
Qualitative analysis
Traditional medicine
Nigeria
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Summary:Nigeria's under-five health outcomes have improved over the years, but the mortality rates remain unacceptably high. The qualitative component of Nigeria's 2019 verbal and social autopsy (VASA) showed that caregivers' health beliefs about causes of illnesses and efficacious treatment options contribute to non-use/delay in use of facility-based healthcare for under-five children. This study explored how these health beliefs vary across zones and how they shape how caregivers seek healthcare for their under-five children. Data for this study come from the qualitative component of the 2019 Nigeria VASA, comprising 69 interviews with caregivers of under-five children who died in the five-year period preceding the 2018 Nigeria Demographic and Health Survey (NDHS); and 24 key informants and 48 focus group discussions (FGDs) in 12 states, two from each of the six geo-political zones. The transcripts were coded using predetermined themes on health beliefs from the 2019 VASA (qualitative component) using NVivo. The study documented zonal variation in belief in traditional medicine, biomedicine, spiritual causation of illnesses, syncretism, and fatalism, with greater prevalence of beliefs discouraging use of facility-based healthcare in the southern zones. Driven by these beliefs and factors such as availability, affordability, and access to and perceived quality of care in health facilities, caregivers often choose one or a combination of traditional medicines, care from medicine vendors, and faith healing. Most use facility-based care as the last option when other methods fail. Caregivers' health beliefs vary by zones, and these beliefs influence when and whether they will use facility-based healthcare services for their under-five children. In Nigeria's northern zones, health beliefs are less likely to deter caregivers from using facility-based healthcare services, but they face other barriers to accessing facility-based care. Interventions seeking to reduce under-five deaths in Nigeria need to consider subnational differences in caregivers' health beliefs and the healthcare options they choose based on those beliefs.
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ISSN:1471-2458
1471-2458
DOI:10.1186/s12889-022-13238-1