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This study was motivated by the observed low life expectancy of men compared to women. Explanations to this observation were sought for in the health seeking behaviour of men in Enugu Metropolis. The study examined the differences in the health seeking behaviour by men of different age groups, educational attainment and income levels in Enugu Metropolis. The study was located in Enugu Metropolis, made up of three Local Government Areas (LGAs) namely: Enugu North LGA, Enugu East LGA and Enugu South LGA. A sample size of 384 men aged 18 years and above was selected through the multi stage sampling technique for the study. Simple percentages, frequencies, tables and charts were used in data analyses. The postulated hypotheses were tested with the aid of Analysis of Variance (ANOVA). The variables of interest included visits to hospital for regular medical checkup, completion of medication, choice of hospital, use of treated insecticidal nets, response when sick, and nature of treatment sought for when sick. Findings showed that income and age influence health seeking behaviour of men in Enugu metropolis. Elderly men were found to be more conscious of their health. Also men of higher income have better health seeking behaviour than those in lower income category. On the other hand, there is slight difference in the health seeking behaviour by men of different education levels since all abuse drugs, practice self-medication, neglect regular medical checkup. However, whenever a case of ill health develops, the more educated men respond more positively to finding appropriate remedy. The study recommended that there should be proactive health care programmes to promote the health of the young and middle aged men who are more reactive in their health seeking behaviour. Also, awareness on the benefits of preventive health practice for men should be intensified.
1.1 Background of the Study
The health of the citizens of any nation is very crucial to the nation’s economic growth and development (Lucas and Gilles, 2004; Oluwatuyi, 2010). On the part of the individual, ill- health is associated with pains, discomfort, stress and loss of income and self-worth and sometimes death. These may cause the afflicted person to question the essence of his/her existence or why it is he/she that is afflicted. Poor health inflicts great hardship on households, including debilitation, substantial monetary expenditures. The health status of adult affect their ability to work, and thus underpins the welfare of the household including children’s development (Asenso-Okyere, Chiang, Thanagata, and Andam, 2011). Often times, treatable diseases go untreated because of lack of access to health care. To avoid the difficulties and inconveniences associated with ill-health, most of which are avoidable some individuals go the extra mile to ensure they stay well. Some engage in regular exercises while others mind what they eat.
Watts (2000) noted that health and illness are inextricably intertwined with economic activity, connecting between what we do, how we earn, what we earn and how we die. According to him, accidents, chronic lung diseases, pneumonia, and influenza, diabetes, suicide, cirrhosis and HIV, along with heart disease, cancer and cerebral vascular disease, were the leading causes of death in most developed economies in recent years. He also observed that beside these disease categories are the habits and activities of many people around the world in recent years. That the modern lifestyle in terms of social life has encouraged people to engage in unhealthy habits such as smoking, drinking, drugging, eating unhealthy food, living and playing among toxins and microbes, having unsafe sex and driving on crowded highways.
Individuals are fully aware of the consequences of their actions, that ill health and illness resulting from peoples actions are their choices (Achime, 2014). Individuals however differ in their choice of treatment sources depending on the type and perceived intensity of sickness, accessibility to the public health facility and demographic characteristics. What people do when they have symptoms of illness has major implications for mobility and progression of the illness and consequences for creating a healthy community. The poor state of health Among Nigerians generally and men in particular are depicted by available statistics. According to the 2014 Nigeria Demographic Health Survey-NDHS, the mortality rate is 13.16 deaths per 1000, infant mortality rates 74.09 per 1000 live birth. In terms of gender, while the mortality rate for male was 79.02 deaths per 1000 live birth, female mortality rate was 68.87 deaths per 1000 live birth. More so the life expectancy at birth for male was 51.63 years, as against 53.66 years for female.
Given these wide differences, explanations tend to revolve on dearth of facilities, dearth of personnel, poor financing. However, it is our contention that while these are themselves problems in the health sector, there is also the issue of responses of Nigerian government to health challenges. For instance in Enugu State, the governments budgetary allocation to the health sector for 2014 was four billion, one hundred and twenty four million Naira (N 4,124,000,000.00), out of a total budget of Ninety three billion, two hundred and eighty seven million Naira (N 93,287,000,000.00) (Enugu State Government, 2014), which constituted twenty three percent(23%) of the entire budget. Also in 2015, Enugu State Government budgeted the sum of four billion, nine hundred million Naira (4,900,000,000.00) for the health sector out of the total of Ninety six billion, seven hundred and thirty five million Naira (N96, 735,000,000.00) (Enugu State Government, 2015), which constituted twenty percent(20%) of the entire budget.
In terms of facilities, there are a total of 10 public secondary health facilities, 200 private health facilities, 176 public health centres, 327 private health centres, and 3 tertiary institutions (referral centres) in Enugu State (NBS, 2009). It is noteworthy that most of the health facilities are located in the urban areas. Despite of the number of health institutions in Enugu State, both public and private, available health statistics show a dismal performance. Assessment of health performance in Enugu State showed that men have 59.6% health complications more than women that have 40.4%. In terms of mortality rate, men have 20.2% higher than women that have 19.3 (Ezeala-Adikaibe, Aneke, Orjioke, Ezeala-Adikaibe, Mbadiwe, Chime, and Okafor, 2014). The statistics showed that men in all ramifications were worst off.
The above statistics show that despite efforts of Enugu State government to ensure improved access to health care in the State, the health status of the people is still poor. Expectancy for an adult Nigerian male is 63.5years (News Rescue, 2013). This discrepancy in life expectancy of men and women in Nigeria was better highlighted by National Population Commission (2014), in its 2013 Nigeria Demographic and Health Survey (NDHS), which showed that death rate of adult men between ages of 15-49 was 466,639, whereas adult women was 443,102. Men die at higher rate than women for all the top 10 causes of death. Men’s health is an area of public concern (Baker, 2002; European Commission 2011; white, 2006), which prior to the year 2000 has been a relatively under research area (Baker, 2002; Coutenay, 2000b; Meryn and jadad, 2001; Gough, 2006).
The health seeking behaviours and beliefs of men have been implicated in the health difference between men and women. It is well documented that men are reticent about accessing health care services (white, 2001; Banks, 2001; Gough, 2013), and are less likely to visit their general practitioners when ill (ONS, 2011). Evidence also suggests a tendency for men to present at the latter stages of illness or when disease has reached the more critical stages (European Commission, 2011). Based on the foregoing, the study seeks to look at basically the attitude of men towards addressing their health problems in the midst of the quality health services available particularly in Enugu state.
1.2 Statement of the Problem
There are social, cultural and political factors that contribute to inequitable health outcomes, the bare of the Nigerians health care system (Orubuloge, 2003). Some of the factors are the neglect and decay of government health facilities in the decades, the political instability that the country has witnessed since independence in 1960, coupled with the various economic problems.
The doctor-patient ratio was also implicated in the rising death profile and worsening health conditions of Nigerians. Nigeria has inadequate medical personnel to handle the numerous health challenges of Nigerians. Records showed that in 2011, the registered medical practitioners was 28,456, Dentists 935, Midwives 90,489 in 2007, Nurses 128,918 in 2007, Public Health Nurses 4,308, Peri-operative Nurses 1,794 in 2007 and Pharmacists 7,581 in 2010 (National Bureau of Statistics, 2012).
However, one would be expecting that men in Enugu State, being the Regional Headquarters of South East Nigeria, will be taking advantages of health infrastructures to take care of their health problems. Record of public health facilities in Enugu State showed that the state has 176 public health centers (PHC), 10 secondary health facilities, and 3 tertiary health institutions, 327 private health centres, and 200 private secondary health facilities ( National Bureau of Statistics 2009). It is therefore justifiable to say that the available health facilities in Enugu State are expected to provide the needed health care for the projected population of 3,796.684 people in the state according to NBS (2012).
Notwithstanding, the state of some of the health infrastructures might be affecting the health seeking behaviour of the people (Oluwatuyi, 2010). It is noted that health seeking behaviour is the activity undertaken by individuals who perceive themselves to have health problem or to be ill for the purpose of finding appropriate remedy (Afolabi, Dapapale, Irinonye, and Adegoke, 2013). Women in Enugu State seemed to be taking advantage of the few available health facilities in the state to improve on their health more than men which probably explains why they have better health outcomes more than men as showed in the study by Ezeala-Adikaibe,et al. (2014)
It is generally believed that poor health seeking behaviour of men is a major factor responsible for low life expectancy among men. This therefore explains why most obituary announcements involving men usually end in “he died after a brief illness”. Men have health complications and deaths more than women ( Ezeala-Adikaibe,et al., 2014). The situation is traceable to poor health seeking behaviour among men. Any human being who is not connected to a physician to screen for major health problems is at greater risk of disease and death. The biggest problem that men have is not so much a specific disease, but the disease is the result of lack of health care monitoring earlier in life.The poor attitude to health care seeking among men results to their worse state of health and subsequent death. Therefore, this study is set out to critically determine the health seeking behaviour of men in Enugu Metropolis.
1.3 Objectives of the Study.
The general objective of this study is to determine factors responsible for health seeking behaviour of men in Enugu metropolis.
However, the specific objectives are:
1. To determine the differences in the health seeking behaviour of men of different age groups in Enugu metropolis.
2. To determine the differences in the health seeking behaviour of men of different income levels in Enugu metropolis.
3. To determine the differences in the health seeking behaviour of men of different education levels in Enugu metropolis.
1.4 Research Questions
To realize the objectives of the study, the researcher posed the following research questions:
i. How do men of different age groups in Enugu metropolis seek health?
ii. How do men of different income levels in Enugu metropolis seek health?
iii. How do men of different education levels in Enugu metropolis seek health?
1.5 Research Hypotheses
In line with the above stated objectives of this study, the following hypotheses are postulated:
Ho: There is no significant difference in health seeking behaviour among men of different age brackets in Enugu metropolis.
Ho: There is no significant difference in health seeking behaviour among men with different levels of income in Enugu metropolis.
Ho: There is no significant difference in health seeking behaviour among men with different levels of Education in Enugu metropolis.
1.6 Significance of the Study
This research work would have a practical significance of determining the factors responsible for the health seeking behaviour of men in Enugu metropolis. The study will also reveal how health seeking behaviour of men impact on their health outcomes. More so, the research will provide insight and guidance to government and other health care providers to design a good health framework that will promote good attitude towards health care seeking among men in Enugu metropolis and the State in general.
On the other hand, this study will serve as a reference to students and researchers who will further carry out study on health seeking behaviour of men in Enugu State. It will also contribute to available literature on health seeking behaviour of residents of Enugu State and Nigeria in general.
1.7 Scope of the Study
The scope of this study was limited to Men in Enugu metropolis who are suspected to have poor health seeking behaviour despite availability of health facilities within the metropolis. Also, the research work covers Enugu metropolis made up of Enugu North, Enugu East and Enugu South local Government Areas (LGAs), which are metropolitan LGAs of Enugu State.
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