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Year : 2021  |  Volume : 30  |  Issue : 5  |  Page : 581-585

Healthcare-seeking behavior of parents and guardians of school children with skin diseases in Umuahia, South East Nigeria

1 Department of Paediatrics, Federal Medical Centre, Umuahia, Abia State, Nigeria
2 Department of Internal Medicine, Alex Ekwueme Federal Teaching Hospital, Abakaliki, Ebonyi State, Nigeria
3 Department of Paediatrics, University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu State, Nigeria

Date of Submission02-Jun-2021
Date of Decision22-Jun-2021
Date of Acceptance30-Jul-2021
Date of Web Publication11-Oct-2021

Correspondence Address:
Dr. Chikaodili Adaeze Ibeneme
Department of Paediatrics, Federal Medical Centre, Umuahia, Abia State
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/NJM.NJM_103_21

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Background: Skin disorders are often not regarded as major health problems although they may be an early sign of a serious disease. This attitude may affect the healthcare-seeking behavior of either the parents or guardians of school children that have skin diseases. Knowledge of the source of treatment and care for diseases of the skin will assist in the implementation of important skin health education programs and appropriate measures for the prevention of their diseases. Objective: To identify the source of accessing health care and the factors influencing healthcare-seeking behavior of parents/guardians of primary school children with diseases of the skin in Umuahia, South-East, of Nigeria. Subjects and Methods: This was a descriptive cross-sectional study carried out over a four-month period. To select the school children multistage sampling was used. A structured questionnaire administered by the interviewer was used to obtain relevant information. Diagnosis of skin disorder was by clinical examination and laboratory investigations. Analysis of the data was done using SPSS version 20. Results: Skin diseases were identified in 627 (40.2%) out of the 1560 primary school pupils aged 5–15 years. Of the 627 children with skin diseases 423 (67.4%) sought health care outside the hospital while only 204 (32.6%) sought medical care in the hospital. Long waiting time (31.0%) and cost of hospital care (26.6%) were observed to be the most frequent reasons for not seeking medical care from the hospital. Conclusion: About two-third of parents/guardians of school children with skin diseases access health care outside the hospital. Cost of care and waiting time should be reduced to enable access to hospital care.

Keywords: Health-seeking behavior, parents, school children, skin diseases

How to cite this article:
Ewurum O, Ibeneme CA, Nnaji TO, Ikefuna AN. Healthcare-seeking behavior of parents and guardians of school children with skin diseases in Umuahia, South East Nigeria. Niger J Med 2021;30:581-5

How to cite this URL:
Ewurum O, Ibeneme CA, Nnaji TO, Ikefuna AN. Healthcare-seeking behavior of parents and guardians of school children with skin diseases in Umuahia, South East Nigeria. Niger J Med [serial online] 2021 [cited 2021 Nov 29];30:581-5. Available from: http://www.njmonline.org/text.asp?2021/30/5/581/327944

  Introduction Top

Skin diseases are commonly seen in the tropics and constitute common causes of morbidity.[1] The disfigurement and distress of skin diseases may result in loss of function, pain, and itching as well as cosmetic and social problems.[1] Skin diseases contribute to the risk of other life-threatening illnesses such as glomerulonephritis, carditis, arthritis, and septicemia.[2],[3] Healthcare-seeking behavior encompasses all the activities carried out by individuals for the purpose of finding an appropriate remedy for their perceived health problems.[4] Help is sought on health issues due to several reasons including the type and severity of illness, availability, and access to services and finance. Some of the factors which have been noted to influence the choice of treatment are socioeconomic status, cultural factors, and gender.[5] There is an indication that poor access to health facilities, delay in getting attention, and the high cost of prescribed drugs affect the utilization of public health services, thus increasing the patronage of other treatment sources such as drug peddlers, community pharmacies, herbal medicine, religious or spiritual care organizations, and students in health-related academic disciplines.[6]

The healthcare-seeking behavior for skin diseases in our environment is low as is the case in some industrialized countries.[7],[8] In a study by Emodi et al.,[9] in Enugu, skin diseases accounted for only 1.3% of children's outpatient clinic attendance over a 10-year study period. Amoran et al.,[10] in Sagamu found that caregivers of most of the children (92.5%), did not visit a health facility for the diseases they had on their skin, while 137 (70.3%) practiced self-medication. Similarly in Dar es Salam,[11] it was observed that for most of the children (67.2%), parents were not able to seek any form of care when they had skin diseases. This attitude may follow the belief that skin diseases are a benign minor nuisance that does not require any treatment.[12] The frequent accessibility of over-the-counter drugs in Nigeria also contributes to poor patronage of health-care facilities[9] and subsequent mismanagement of these skin disorders.

Odueko et al.[13] noted that misdiagnosis of skin diseases commonly leads to wrong treatment, which can consequently progress to complications such as septicemia and renal damage. Skin diseases may affect young people socially and academically because of low self-esteem with a resultant poor concentration in their studies.[14] In older school children in India, especially females, acne has been reported to cause psychosocial abnormalities including depression, suicidal ideation, and anxiety.[15] Fungal and viral infections can have a secondary bacterial infection and other complications such as scarring alopecia with tinea capitis, malignant transformation in genital warts, and pneumonia in varicella infections.

A community-based data on the health-seeking behavior of the parents/guardians of children with skin disorders would help formulate evidence-based strategies to implement relevant skin health education programs and appropriate preventive measures and provide care for children with skin diseases through effective health-care planning and proper allocation of health resources in the communities.

  Subjects and Methods Top

This descriptive cross-sectional study was conducted in both public and private primary schools situated in Umuahia South Local Government Area, Abia State, from December 2016 to March 2017. The list of all primary schools in the 44 communities was obtained from the Abia State ministry of education.[16] A total of seven schools were selected through multistage sampling. Systematic sampling was used to select eligible subjects.

The Health Research Ethics Committee of the Federal Medical Centre, Umuahia gave ethical clearance prior to the study while the State Ministry of Education granted permission for the study. Parents or guardians of the selected students gave their informed consent before enrolling their children or wards into the study. Assent was sought from children who were up to seven years and could understand the explanations given to them.

Skin diseases were diagnosed based on history, clinical examination and laboratory investigation where indicated. Laboratory tests carried out for the diagnosis of skin diseases were skin scrapings for microscopic view and potassium chloride analysis, skin swab microscopy, culture, and sensitivity as well as skin biopsy. A pretested self-administered, close-ended questionnaire was used to get information from the respondents. The questionnaire was divided into three sections to obtain the required information such as sociodemographic factors, history of the skin diseases and healthcare-seeking behavior of parents/guardians. Socioeconomic status was determined by employing the scoring system designed by Oyedeji.[17] This was further stratified as upper (Class I and II), middle (Class III) and lower (Class IV and V) as has been used in a previous study.[18]

The questionnaire design in this section was based on a conceptual structure from a review on the determinants of health-seeking behavior[4],[5],[19] which had been used in earlier studies.

A list of different sources of health care available in the community was given to the respondents to identify the preferred type and indicate the frequency of patronizing them. A five-point Likert scale (never, rarely, often, very often, and every time with values of zero, one, two, three, and four, respectively) was used to indicate the frequency of patronage of health facilities. The extent to which the perceived barriers limited the utilization of health centers by the respondents was also measured using the same five-point Likert scale described above.

The parents and guardians of children were notified of any serious skin disease their children had and were referred to the consultant Dermatologist at the Dermatology clinic of Federal Medical Center Umuahia for further management. For children with milder skin lesions, appropriate treatment was prescribed at the time of examination. This treatment was explained to the teacher so that he/she could instruct the parents or guardians of the pupils. The second edition of the international classification of primary care was used to classify the skin diseases.[20]

Data analysis

The data were analyzed using Statistical Package for Social Sciences (SPSS) software version 20.0 for Windows ® (IBM SPSS Inc. 2011 Chicago, Illinois, USA). Descriptive statistics including frequency, means, and proportions were calculated. The 95% confidence interval was calculated for proportions. Descriptive statistics was employed to analyze the relative influence of the conditions that affect health-seeking behavior and the use of various types of health-care sources available in the community. P ≤0.05 was set as the level of significance.

  Results Top

General characteristics of the study participants

One thousand and five hundred and sixty pupils were recruited into the study and comprised 713 from private and 847 from public schools. The children were aged 5–15 years with a mean age of 8.74 ± 2.079 years. The mean age of the public school pupils was significantly higher than that of the private school pupils (9.12 ± 2.08 vs. 8.30 ± 1.99 t-test − 7.85 P < 0.001). [Table 1] shows the general characteristics of study participants.
Table 1: General characteristics of study participants

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Diagnosis of skin diseases among primary school children

Skin diseases occurred in 627 out of the 1560 primary school pupils studied giving a prevalence of 40.2%. Of the 713 private school pupils, 237 had skin diseases giving a prevalence of 33.3%. In public schools, 390 out of 847 had skin diseases with a prevalence of 46%. Tinea capitis was the single most common and also the most common infective skin disease. Other infective diseases observed include pityriasis versicolor, scabies, tinea corporis and carbuncles/furuncles. Miliaria was the commonest noninfective skin disease noted in this study followed by papular urticaria, acne, seborrheic dermatitis, and atopic dermatitis. [Table 2] shows the skin diseases observed in the primary school children.
Table 2: Diagnosis of skin diseases in the primary school children

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Sources of accessing health care by parents/guardians

Out of the 627 children with skin diseases, 423 (67.4%) sought health care from other places outside the hospital for their skin diseases while 204 (32.6%) sought medical care in the hospital. Of the 204 times hospital care was sought, the parents and guardians of the private school children contributed 124 (60.8%) times. The parents and guardians of the public school children contributed 85.7% of the total number of times herbal remedies were used. [Table 3] shows the sources of health care by parents/guardians.
Table 3: Distribution of sources of health care by parents/guardians according to type of school

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Reasons reported by parents for not visiting the hospital for treatment of skin diseases according to the type of school

Long waiting time is the most frequent reason for not seeking medical care from the hospital followed by the cost of hospital care. These reasons were given by 31.0% and 26.6% of the parents/guardians, respectively. More than 10% of the parents/guardians reported far distance from home as a cause of non-utilization of the hospital. [Table 4] shows the reasons reported by parents for not visiting the hospital for treatment of skin diseases below.
Table 4: Reasons reported by parents for not visiting the hospital for treatment of skin diseases

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  Discussion Top

Skin diseases among children have been a subject of interest to workers in different parts of the world. The 40.2% prevalence of skin diseases in this study is in support of the assertion by other researchers that skin diseases are common in primary school children.[21],[22],[23],[24],[25],[26]

The desired healthcare-seeking behavior is for an individual to respond to an episode of illness by asking for assistance from a trained doctor, in a recognized health-care setting. However, it has been observed that people choose traditional and folk medicine, as well as providers in a variety of contexts that have potentially profound impacts on health. When individuals make decisions in relation to their health, they weigh the potential risks or benefits of that behavior and do so in a way that is mediated by their immediate practical environment, their social rootedness, and their whole outlook on life generally.[4] School children do not have this ability and depend on their parents and guardians to decide for them.

The majority of the parents of school children with skin diseases in this study (67.4%) did not seek medical care for their children's skin conditions similar to 67% and 70% documented by Komba and Mgonda,[11] in Tanzania and Fung and Lo,[7] in Hong Kong, respectively. Amoran et al.[10] in Sagamu had a higher proportion of 92.5% of parents and guardians who were not able to seek medical care in their study. The low level of health-seeking behavior may be attributable to the fact that skin diseases are assumed to be a benign minor nuisance not meriting any treatment.[12]

Waiting time at the hospital and cost of hospital care were the leading reasons why respondents in the present study decided not to visit the hospital. This agrees to the finding with Afolabi et al.[5] in Ile-Ife where they observed that the cost of care and excessive waiting time were the major barriers that were perceived against the effective patronage of health facilities for medical care. The experience of protracted waiting time in a health system by a patient can influence his or her views on the quality of service radically and may become a reason for not patronizing a standard health facility.[27],[28] High cost of medical care documented in this study may also have contributed to the fact that more than 67% of parents sought health care outside the hospital. Similarly, Uzochukwu and Onwujekwe,[19] in South-Eastern Nigeria, observed that participants with low income often sought health care from the traditional healers, patent medicine dealers and community health workers, while those with higher income used the services of private clinics, public health centers and hospitals that offered better quality of services. This may be as a result of the high fees paid in public and private health institutions. The health system, especially the public type, has been undermined by the continued difficulties in the economy with resultant increased patronage of the unorthodox private sector like the drug peddlers and hawkers, patent medicine dealers without licenses, traditional healers etc., The health services offered by this sector are likely to be cheaper, of very low quality and as well very close to the populace. It can also be an important source of prevention and treatment of diseases for the poor. In Nigeria, it appears that there are no regulations of advertisements in the media by traditional medicine dealers who challenge the use of orthodox medicine openly, thereby popularizing them especially among the poor, a trend which should be curtailed.[19]

Contrary to the findings in this present study, Uzochukwu and Onwujekwe,[19] in their study noted that the major reasons that deterred the poorest households from utilizing the Bamako initiative health facilities for malaria treatment were poor staff attitude and lack of drugs. Adedini et al.,[29] reported that resource-related barriers such as difficulty in getting money required for treatment, lack of health workers and poor supply of drugs were statistically significant barriers to seeking health-care services.

In the present study, the parents and guardians of the private school children sought health care more frequently from the hospital than other sources. However, those of public schools used more herbal remedies for the treatment of their children and wards skin diseases. The use of herbal remedies for skin disorders may be due to their availability and perceived side effects of chemical drugs. However, it must be noted that there is no standardization of the active ingredients' purity or concentration of the substances in these herbal remedies and thus should be used with caution. It was also noted that the high cost of hospital care was a more common hindrance to accessing health care in the hospital for parents and guardians of public school children while waiting time was more common for private school children. This may probably be related to the higher level of socioeconomic status of parents and guardians of private school children noted in this study; therefore, their reluctance to wait patiently for the time they will be seen since they can readily afford other sources of care such as procuring drug from the pharmacy. In a conventional health facility like the hospital, patients are attended to in various departments; thus, the long waits at the medical records, doctors consulting room, and laboratory among others could result in dissatisfaction with the services rendered.

Providing health-care centers with adequate facilities and trained personnel counseled on the need for prompt response, creating awareness to the immediate communities on their existence and educating them on the need to seek health care in these centers, would encourage prompt health-seeking of parents and guardians at the onset of ill-health at health-care facilities for treatment of their children's skin diseases and other illnesses that may arise. This in the long run will reduce the costs of mortality and morbidity.

  Conclusion and Recommendation Top

Most parents and guardians of primary school children access health care outside the hospital due to long waiting time at the hospital and the cost of hospital care. Obstacles to effective health service delivery such as high cost of care and long waiting time should be reduced to enable children access health care in the hospital especially for skin diseases.

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Conflicts of interest

There are no conflicts of interest.

  References Top

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  [Table 1], [Table 2], [Table 3], [Table 4]


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