Factors Associated With Health Seeking and Utilization Behaviour among the Somali Community in Garissa County, Kenya

Abstract

Appropriate healthcare seeking could prevent a significant number of deaths and complications due to ill health. Unfortunately, healthcare seeking behaviors (HSB) differs according to place, the affected, disease types, beliefs and the opportunities to seek care. These decisions are not isolated to individuals but are embedded in a broader household and social organizational decision process and the capacity to allow seeking of care. It is important that health care is sought from a health provider who can accurately diagnose and initiate prompt treatment appropriately. Garissa is a geographical region marked by lack of one or more of the following five conditions: access to improved water, access to sanitation, durable housing, sufficient living area, and secure tenure essentially presents risk factors for morbidity and mortality. Evidence from studies in Kenya demonstrate that morbidity and mortality in Garissa and similar counties are much higher than the national averages. To mitigate these high rates of morbidity and mortality, this study set out to determine factors that influence healthcare seeking and utilization behaviour among the Somali Community in Garissa County, Kenya. This descriptive cross-sectional community-based study used a multistage cluster sampling method to enroll consenting adults from different households located in the seven (7) sub-counties in Garissa County. The data were collected by interviewing 405 adult population using pretested structured questionnaires. Descriptive statistics frequency (%), mean, standard deviation and medium (interquartile ranges at 25% and 75%) were used to express quantitative data while logistic regression analysis was used to evaluate factors associated with health seeking behavior using STATA version 13 at the significance level of P ≤ 0.05. Among the surveyed respondents, the mean age (±SD) was 35.17 (12.9) years, 68.1% had no formal education, 72.8% were female and 81.2% were married. Health care seeking during the latest illness was reported by about three quarters of the respondents (n=293, 72.3%). The treatment or advice during the latest illness was sought by the majority in the Government / public hospitals (n=228), followed by in the private hospitals (n= 37) and among Traditional or homeopathic or spiritual healers (n = 28). In multivariate analysis, household headship, possession of health insurance, reasons for choosing preferred healthcare facility, durations prior to seeking treatment and the perceived three common illnesses in the community were associated with seeking treatment during the latest illness both in any of the healthcare facility and in the government/public hospitals. Gender, occupation and reasons for choosing preferred healthcare facility independently influenced seeking treatment during the latest illness both in any of the health facility and in private hospitals. Durations prior to seeking treatment was the only independent factor associated with seeking treatment both in any of the healthcare facility and among Traditional or homeopathic or spiritual healers. Gender, occupation, household headship, possession of health insurance, reasons for choosing preferred hospital, availability and the preference of current health facility, duration with illness and perceived illnesses in the community are the predictors of HSB. Improvement in education, health facilities and medical services in the community, introduction of community based integrated management of common community illness are imperative to improve HSB among the Somali community in this Semi-arid region of Kenya.