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Journal of Nepal Health Research Council Vol. 2 No. 2 October 2004 Health Seeking ……
14
Health Seeking Behavior of Rajbanshi Community in Katahari and
Baijanathpur of Morang District, Nepal
Subba NR
a
Abstract
Introduction In Nepal there are numbers of ethnics having their own traditional health seeking behavior. Rajbanshi is one
of the indigenous people of Morang district whose health seeking behavior varies depending upon their
socio-economic status.
Objectives The objective of the study was to assess the practices of using modern, self and alternative medication on the
basis of socio-economic status.
Methods The study was a cross sectional study of descriptive type. Information has been collected from the field
survey by using semi-structured questionnaires containing both open and close ended questions. Total 175
households of two VDCs was selected from the VDCs rosters using random number table for convenience
and to cover the expected households. Data were analyzed utilizing the Epi Info 6.0 version.
Results Modern, Alternative and Self medications were common in Rajbanshi community. Modern medication was
popular but was expensive to afford as reported by majority people. Significant proportion of Rajbanshi
people having less than 2 bigahas land and uneducated was adopting self medication in Katahari and
Baijanathpur of Morang.
Conclusion There is a relationship between economic, education status and health seeking behavior in Rajbanshi
community.
Key words Health, Behave, Alternative and Self-medication
Introduction
Health Seeking Behavior is a usual habit of a people or a
community that is resulted by the interaction and balance
between health needs, health resources, socio-economic and
cultural as well as national/ international contextual factors
1
It
is behavior of using health services within existing health
system or treatment seeking behavior of the latest illness as
reported by them. This was categorized as (a) Modern
medication such as Hospital, HP/SHP and private clinic (b)
Alternative medication such as Ayurvedic and Homeopathic
system of medication; and (c) Self-medication such as
Dhami/Jhakri (Shaman healers), drug retailers, grocery
keepers, drug peddlers, household medicine and other than
modern and alternative medication. Kafle and Gartoulla
2
and
Gartaula
3
have categorized self medication as Shamanism,
Priest, Dhami-Jhakri, herbal, drug retailers, grocery, kit-bag,
drug peddler, neighbour, following old medicine prescriptions
etc and except the present prescription by qualified medical
practitioners. WSMI
4
has indicated as Self-medication is the
use of specifically designed, labeled and authorized medicines
available legally without prescription for the treatment or
prevention of common illnesses, which can be recognized by
the people. Traditional medicine is not included in the national
health system. If traditional medicines are legally available
without a doctor's prescription, then they are included in what
we call self-medication. Alternative medicine is medicine
which is outside the regular allopathic medicine
5
. Sometimes
it is accepted by national health plans for coverage and
sometimes it is not
6
. This would cover for example,
acupuncture, ayurvedic, naturopathy, and homeopathic
medicine etc
Methodology
This is a cross sectional and descriptive type of study based on
information acquired from field visit carried out in January
2001. Semi structured questionnaire sheets containing both
open and close ended question regarding health seeking
behavior of the community were administered to 175 sample
households of Katahari and Baijanathpur Village
Development Committee (VDC) of Morang district. Samples
were selected from the VDCs rosters using random number
table and respondents were asked relevant questions with the
history of illness / disease within three months from interview
date. Of those who were ill/sick person of the above criteria
Corresponding Author:
Nawaraj Subba,
E
-
mail:
nrsubba@yahoo.com,
a
Ministry of Health and Population, District Public
Health Office, Morang, Nepal.
Journal of Nepal Health Research Council Vol. 2 No. 2 October 2004 Health Seeking ……
15
were consulted for detailed information otherwise only
demography was taken for the rest. Data were analyzed
utilizing the Epi Info 6.0 statistical package. Data from pre-
coded questions were entered into Epi Info 6.0 database.
Attempts were made to minimize the potential error using
Check file the data entry edit program. The Check file
incorporated skip patterns, legal values and range checks that
facilitated more rapid and accurate data entry. The participants
were requested for Focal Group Discussion (FGD) to have one
and half an hour’s sessions for the reason of their self-
medication during household visits. Personal contacts with
self-medicated population within three months of study period
were made to have 8 persons in one FGD and attempted total
ten FGD with 80 persons. Verbal consent was taken before
taking interviews and FGDs.
Results
Table: 1 Education and Sickness (n=175).
Education Sickness (n) Percentage
Educated 45 26.0
Uneducated 130 74.0
Total 175 100.0
Table 1 presents the status of sickness on the basis of
educational level in the community. Proportion of felling sick
of uneducated was higher as 74.0 percent (130) than educated
26.0 percentage (45). SLC pass and above was considered as
educated and SLC failed and below were considered as
uneducated in the study.
Table: 2 Education and Medications (n=175).
Medications Uneducated (n=130) Educated (n=45) P - Value
Modern Medication 126 (96.9) 42 (93.3) 0.3753
Self-Medication 85 (65.4) 14 (31.1) 0.0000063
Alternative Med. 27 (20.8) 13 (28.8) 0.2635
Table 2 indicates that practice of using self-medication by uneducated Rajbanshi was significantly higher than educated
(P<0.05).
Table: 3 Medications by Economic status (n=175).
Medication <2 Bighas land (n=107) 2.1-4 Bighas land (n=22) >4 Bigha land (n=46) P - Value.
Modern Medication 104 (97.2) 20 (90.9) 44 (95.6) 0.3871
Self-Medication 68 (63.6) 14 (63.6) 18 (39.1) 0.0160
Alternative Med. 19 (17.7) 7 (31.8) 40 (87.0) 0.0000
Table 3 presents that people having less than 2 Bighas land
were adopting self medication significantly (P<0.05).
Likewise, people having more than 4 Bighas land adopting
alternative
medication was also significant (P<0.05). People were
classified into three categories on the basis of land ownership
as (a) Less than 2 Bighas, (b) 2.1-4 Bighas, (c) More than 4
Bighas.
Table 4: Diseases reported during encounter with the respondents (n=175).
S.No. Diseases Frequency Proportion Percentage
1 Headache,bodyache,weakness 89 50.8
2 Acute Respiratory Infection (ARI) 77 44.0
3 Fever 54 30.8
4 Eye/ENT/Oral Problems 33 18.8
5 Diarrhoea/Dysentry 24 13.7
6 Gastritis(APD) 24 13.7
7 Skin diseases 13 7.4
8 Tuberculosis 10 5.7
9 Rheumatoid Arthritis 9 5.1
10 Asthma (COPD) 7 4.0
Journal of Nepal Health Research Council Vol. 2 No. 2 October 2004 Health Seeking ……
16
Table 4 shows that symptoms like headache, bodyache,
weakness and fever were reported by more than 30 percent
respondents. ARI, Diarrhoal diseases, APD were reported by
more than 13 percent respondents. Skin diseases, tuberculosis,
rheumatoid arthritis were reported by more than 5 percent
respondents.
Table 5: Medication sought by the family (n=175).
Medication Number Proportion Percentage
Modern medication 168 96.0
Self-medication 100 57.1
Alternative Medication 40 22.8
Table 5 presents medications sought by the family in any kind
of latest illness during past three months. Modern, self and
alternative medications were sought by 96%. 57.1% and
22.8% respectively.
Table: 6 Expenses for Treatment (n=168).
S.N. Topics Cost in Rupees Proportion%
1.
Purchasing drugs 598.35 58
2.
Paying fees 201.68 19.5
3.
Transportation 52.30 5
4.
Helper 38.58 3.7
5.
Other 142.77 13.8
Table 6 indicates that bulk amount of expense goes on
purchasing drugs (58.0%), followed by paying doctors fees
(19.5%). And 5.0 percentage cost goes for transportation, 3.7
percentage for helper and 13.8 percentage for others. Average
expenditure per sick respondent was Rs.1031.64
Table: 7 Affordability as perceived by the Respondents (n=175).
Affordability Number Percentage
Yes 47 26.8
No 128 73.2
Total 175 100.0
Table 7 suggests that 73.2% people were reported inability to afford the cost for treatment.
Discussion
Katahari and Baijanathpur VDCs are located nearby
Biratnagar sub metropolitan city. Private allopathic clinics
conducted by paramedics were abundant in the local market,
which were familiar also in the community. So, minor injuries
and ailments were being treated there. They have also got
facility of Koshi Zonal Hospital for emergency and special
services. People those who need higher services for
emergency, obstetrics and chronic cases, used to go to higher
service centers located at Biratnagar, Dharan, Kathmandu and
even India. Rajbanshi people were deeply attached with their
Self-medication practices. They readily go to
Dhami/Jhakri/Shaman due to their cultural factor and because
of their perceived satisfaction. During FGD it was noted that
lack of adequate money to pay for modern medication also
leads them to go for Self-medication. Poor Rajbanshi adopted
self medication was significant (P=0.05) in Katahari and
Baijanathpur VDCs (Table 3). Similarly, practices of using
self-medication by uneducated was highly significant (P=0.05)
in the community (Table 2). Niroula, B.B.
7
noted in Benighat
that going to a faith healer is a ritual for seeking treatment, but
if the illness persists even after two or three visits to a healer,
the people of Benighat seek modern medicine. Many of them
also use self-medication, with medication bought at the
medicine shop. Others try herbal medications they have tried
before. However, treatment-seeking behavior is changing with
the availability of the modern health care facility in the area.
Treatment-seeking behavior is largely determined by types of
illness and popular beliefs regarding them. The cultural
diversity brought about by caste and ethnic mix and
topographical variations extends to health-seeking behavior.
Some of the health beliefs may be common to all caste-ethnic
groups but some are more specific to a particular caste and
ethnicity. Developments in modern medicine and expansion of
modern health care facilities have played a very important role
in reducing morbidity and mortality in the developing world.
Despite a steady penetration of modern health care services,
economic underdevelopment has also led to a relatively weak
health infrastructure in Nepal. Health improvement
programme A Summary report
8
has revealed that 20 percent
disadvantaged and 11 percent general population in Eastern
development region were getting treatment from traditional
healers. However, modern, self and alternative medications
were indispensable part of health seeking behavior (Table 5)
in Rajbanshi community.
Journal of Nepal Health Research Council Vol. 2 No. 2 October 2004 Health Seeking ……
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An average treatment cost per case was Rs. 1031.64 (SD=6).
They had taken either loan (14%) or had to sell land, animals,
grains or personal belongings (53%). The bulky proportion
(57.8%) expenses felled on buying drugs and for fees
(19.55%) thereafter, for transportation 5 percent, helper 3.74
percent, others 13.84 percent (Table 6). Seventy three percent
respondents reported inability to afford the expenses for
modern medication (Table 7). The issue of expensive medical
treatment and difficulty in affordability was also pointed out
during focus group discussions. Therefore, the cost for modern
medical treatment was said to be unaffordable for majority of
people in Rajbanshi of Katahari and Baijanathpur of Morang.
According to public health point of view, it is one of the major
causes for poor access to health care services for needy
people.
Rajbanshi
9
is one of the 61 ethnic groups in Nepal. Ethnic or
Indigenous people are having low health status in the world
10
.
Tamang A et.al.
11
described treatment seeking behavior which
is determined by perceived causes of reproductive health
problems. The family members believe that modern medicines
will not work (ineffective) if the patient is not first seen by a
faith healer. Visit to a health facility becomes inevitable only
when problem gets worse or unbearable. Because of their
beliefs on witchcraft, reliance on traditional faith healer (TFH)
for treatment is quite strong among all the ethnic communities.
Tamang girls would confide their Severe Reproductive Health
problems with their mothers who would in turn prescribe
herbal/home made remedies. Reliance over Traditional Faith
Healer for treatment of problems is also common among
Tamang girls. A large proportion of adolescent had
experienced menstrual, reproductive or urinary tract disorders
and only few had sought care. There is a need to tailor
program to suit the needs of specific ethnic groups.
Uneducated Rajbanshis reported more sickness than educated
people (Table 1) and they are also using more self medication
(Table 2) in Katahari and Baijanathpur in Morang. A number
of studies have found a correlation between knowledge and
delayed diagnosis. Knowledge includes the ability to
recognize symptoms, identify causes and transmission routes,
and familiarity with the availability of cure. Although the
evidence doesn’t conclusively suggest that knowledge
independently determines care-seeking behavior, the
correlation about knowledge and timing of diagnosis is well
documented
14
.
Diseases reported by more than thirty percent respondents
were mainly symptoms like headache, bodyache, weakness
and fever. ARI, Diarrhoeal diseases, APD were reported by
more than 13 percent respondents. Skin diseases, tuberculosis,
rheumatoid arthritis were reported by more than 5 percent of
respondents (Table 4). Annual Report of Department of Health
Services
12
noted top 5 diseases as skin diseases, ARI,
diarrhoeal diseases, Intestinal worms and Pyrexia respectively.
A study
13
has realized that women could describe only
obvious symptoms of their illness such as headaches, fevers,
joint aches and body aches. They were more knowledgeable
about pregnancy and delivery related problems than illnesses
such as tuberculosis, malaria and typhoid. This lack of
knowledge contributed to their delay in seeking care.
Waisbord
14
felt that the TB control community has recognized
and addressed system components in which behavior is a key
issue. Both diagnosis delay and non-completion of treatment
are two central behavioral challenges. Several ongoing
national and global initiatives that are part of TB control
programs also aim to address behavioral challenges. Programs
that offer enablers such as transportation and food subsidies
for patients assume that by minimizing costs the numbers of
patients seeking diagnosis and care would increase. Murphy
EM
15
, argued that in an earlier day, the task of changing health
related behavior was thought to be simply a matter of sending
health messages such as “Breastfeed your baby!” or “Use
condoms!” to those who were perceived to need them—a one
direction communication approach. Today, sound health
promotion programs no longer rely on one shot exhortations
via booklets, posters, or media broadcasts. They encompass
extensive research on relevant audiences; skill-building; multi-
channeled education and advocacy using influential persons;
policy development; community mobilization; and
organizational, economic, and environmental change. This
approach recognizes that human beings live in a dynamic
“social ecology” as well as a physical one. Because poverty,
gender inequity, and other disparities are underlying causes of
under nutrition, addressing this health problem requires
behavior change at multiple levels.
Conclusion
Modern, self and alternative medications were indispensable
part of health seeking behavior of Rajbanshi community in
Katahari and Baijanathpur VDCs of Morang. Modern
medication was equally popular in both poor and rich or
educated and uneducated. But, majority of people had reported
modern medication as expensive medication. Uneducated
Rajbanshis reported more sickness. Significant number of
Rajbanshis having less than 2 Bighas of land and uneducated
were adopting self medication in the community.
Acknowledgement
I would like to extend my sincere gratefulness to Dr. A.B.
Joshi and Dr. Ritu Prasad Gartoulla for providing valuable
guidance to conduct this study. Acknowledgement is also due
to cooperation provided by the local communities, school
teachers, health workers of Katahari and Baijanathpur VDCs
of Morang.
Journal of Nepal Health Research Council Vol. 2 No. 2 October 2004 Health Seeking ……
18
References
1. M Corlien. Designing and conducting Health
System Research Projects, Health System research
training series, WHO/IDRC, 1991.
2. K. Kafle and Gartoulla RP. Self-medication and its
impact on essential drugs scheme in Nepal. WHO.
DAP – 10, 1993.
3. Gartoulla RP. An introduction to medical sociology
and medical anthropology, RECID, Kathmandu,
Nepal. 1998.
4. Reinstein J. World Self Medication Industry
(WSMI), UK, www.wsmi.org, 2001.
5. Agarwal SK. A guide to Alternative medicine,
Indian board of Alternative Medicine (IBAM),
Calcutta, India.
6. Gartoulla RP. Therapy pattern of conventional
medicine with other alternative Medicine, RECID,
Kathmandu, Nepal, 1998.
7. Niroula BB, Use of health services in Hill villages in
Central Nepal, Population Studies Center,
University of Pennsylvania, Philadelphia, 1994
8. Subba NR, Poudel D and Karkee S. Health
Improvement Programme Summary report,
HMG/MoH/Eastern Regional Health Directorate,
Britain Nepal Medical Trust, 2003
9. Prospectus, HMG, MLD, National Committee for
Development of Nationalities, 2000.
10. Mabuhang BK, Policy Approaches to Indigenous
People on Health Issues, Population and
Development in Nepal Journal, TU CDoPS,
Kathmandu, 2000;7
11. Tamang A, Tamang J and Adhikari R. Severity
Perceptions of Health Problems and Treatment
Seeking Behavior among Adolescent Girls in
Nepal, Conference on Young People’s Sexual and
Reproductive Health Needs in Asia, New Delhi,
2004.
12. Annual Report, Ministry of Health, Department of
Health Services, Kathmandu, Nepal, 2002.
13. World Bank, Understanding Access, Demand and
Utilization of Health Services by Rural Women in
Nepal and their Constraints, 2001
14. Waisbord, Behavioral barriers in tuberculosis
control: A literature review, The CHANGE
Project/Academy for Educational Development,
2005.
15.
Murphy EM, Promoting Healthy Behavior, Health
Bulletin of Population Reference Bureau, USA,
2005; 2
