Also the most important context of the findings for the study exist here as these are the responses from where one can find the relation of the existing social factors with their health seeking practices.
Meaning of factor (noun forms plural: factors), cause; agent; broker; financier; money lender; number which is multiplied with another to produce a given result (Ref: TOEIC Vocab -- TOEIC Vocabulary -- 684 TOEIC Word Lists Online, http://www.english-test.net/toeic/vocabulary/meanings/173/toeic-words).
Definition of factor (FACT) noun [C], a fact or situation which influences the result of something:
People's voting habits are influenced by political, social and economic factors.
Heavy snow was a contributing factor in the acciden.
Price will be a major/crucial factor in the success of this new product.
The economy is regarded as the decisive/key factor which will determine the outcome of the general election.
INFORMAL The film's success is largely due to its feel-good factor (= its ability to make people feel happy). (Ref: Cambridge Advanced Learner's Dictionary, © Cambridge University Press 2004.)
22. Among the interviewed respondents, 48.3% had no knowledge of any UHC/MCWC /FWC nearby, whereas, 51.7% had that knowledge. Lack of the knowledge in the issue reflects possibly their lack of interest in the government service delivery outlets.
The factors related to the development of such knowledge influence health care behavior of an individual for their service seeking.
Here we see that large proportion of the respondents have no knowledge about the presence of UHC (Upazilla Health Complex) or Mother and Child Welfare Centers (MCWC) or Family Welfare Centers, the Government health service delivery centers nearby. It became a burning question, whether is it possible that residing in the area and facing health problems, even if in very small extents, still they didn’t know their presence in the area? In cross-checking of the interview results, it was seen that they really told so. Now, it is a clear cut psychological manifestation. It might be very much possible for a portion of the respondents who responded as they didn’t know the presence of these Government service centers around them, even after knowing the presence, they simply denied their knowledge regarding their presence as they didn’t like them. The social factors here are influencing their mind affecting the development of such "knowledge" of options of health care facilities nearby. This may be possible that they refused to acknowledge the presence of the Government health facilities as they couldn’t satisfy them.
| Knowledge of UHC/MCWC/THC nearby | ||||
|
| Frequency | Valid Percent | ||
| Within knowledge | 168 | 48.28 | ||
| Not within knowledge | 180 | 51.72 | ||
| Total | 348 | 100.00 | ||
23. Among the interviewed respondents, none informed of their regular contact with the Government hospitals for treatment, whereas 27.6% stated that they never go GoB (Government of Bangladesh) outlets for treatment. However, 72.4% go there for treatment only occasionally—factors influencing their propulsion to Government health centers are of importance.
The picture showed the extents of non-confidence in Government health service delivery as most of the respondents informed that they went there only occasionally, i.e. when they badly needed the service, but no body stated that they were going in those government service enters regularly when their family members were diseased! A large proportion of the respondents (27.6%) informed that they never went to the Government health service centers, i.e. hospital etc. So, the health care behavior of the population is special about the Government service centers or hospitals, but what are reasons behind that? It may be the confidence underlying. They know that the services there are not enough effective to meet their needs.
| Whether going government hospital for treatment | ||||
|
| Frequency | Valid Percent | ||
| Don't go to government health facilities | 96 | 27.59 | ||
| Occasionally go to government health facilities | 252 | 72.41 | ||
| Total | 348 | 100.00 | ||
24. Among the interviewed respondents, only 6.9% expressed their satisfaction in treatment in Government service outlets or hospitals any where. A vast majority of 89.7% expressed their dissatisfaction for treatment in Government hospitals, whereas, a much lower proportion (3.5%) stated differently in the issue i.e. too much rush causes trouble for treatment in Government hospitals, without medicines what the doctors would do? There are certain factors like presence of doctors, availability of the medicines, friendly environment in the hospitals etc. influence the individuals’ satisfaction in the service of any care facilities which came later in the findings.
It is interesting that only 6.9% respondents expressed their satisfaction (client satisfaction) in the treatment in the Government hospitals/service centers and about 89.7% expressed their dissatisfaction for their treatment in Government hospitals. But this is also interesting that still they are occasionally going there for their treatment as they have only a few alternatives where they can go for the treatment.
| Whether satisfied in treatment in GOB | ||||
|
| Frequency | Valid Percent | ||
| Satisfied | 24 | 6.90 | ||
| Not satisfied | 312 | 89.66 | ||
| Others | 12 | 3.45 | ||
| Total | 348 | 100.00 | ||
25. Among the interviewed respondents, 82.8% informed "no medicines available" as their reason for not going to Government hospitals (anyone) for treatment, whereas, 65.5%, 44.8% and 41.4% informed of their reasons as the absence of doctors, bad road communication for going for treatment and "bad" behavior of the doctors respectively— "availability of medicines", "absence of doctors", "bad road communication" and "behavior of the doctors" revealed as the factors those play an important role in their perceptions of "satisfaction" in the management of disease in Government hospitals. These are the quantitative and qualitative aspects of a service which are the determinants for service seeking.
-This finding expresses how the service providers’ service quality can affect health care behavior of any population. In health ailments management, the extents of quality and quantity are important factors to attract the beneficiaries and are capable of influencing the target populations’ health care behaviors.
Reasons (if anyone) of not going to GOB
Pct of Pct of
Count Response Cases
Doctors available rarely 228 21.8 65.5
Doctors/providers behavior not good 144 13.8 41.4
No medicines available 288 27.6 82.8
Road communication to government hospital 156 14.9 44.8
Transport not available/expensive 36 3.4 10.3
------- ----- -----
otal responses 1044 100.0 300.0
26. Among the interviewed respondents, all (100%) informed of quack/non-MBBS private doctors as the service outlet for the treatment of their family members, whereas, 82.8% informed both of religious/spiritual healers and Homeopath/Kabiraji/traditional healers for the same indicating the strong affinity of the rural population of Bangladesh for medieval treatment procedures for different reasons. Curiously NGO outlets had been described for the same by only 6.9% of the respondents. These are the health seeking practices evolved for the benefit of the individual as a result of different influencing factors. Factors associated with the choice of the service providers are related with this finding.
All the respondents (100%) informed of their treatment outlets as the quack/non-MBBS private doctors and 82.8% respondents informed both the religious/spiritual healers and Homeopath/Kabiraji/ traditional healers as their treatment outlets. This is really very much interesting! Didn’t they understand any thing about the qualities of treatment of the mentioned outlets? I think at least they assume up to an extent. Then why again they thought theses outlets as their highest hopes? In the next discussion, we shall see the reasons behind this psychology. In practical, they are the "doctors" or the "remedy outlets" where the poor and lees knowledgeable rural people can go in their health problems as they are present in their vicinities, at least the rural people can get them and of course, their treatment is cheap regardless the qualitative standardizations! In medical science, we care about several factors which can affect the healing process strongly like placebo effects (psychological perception of taking appropriate medications), assurance and re-assurances etc which are scientifically proved phenomenon. So, apart from the extents real pharmacological effects, added psychological boost benefits the service seekers and thus contributing to the health care behaviors, i.e. the people come to them in diseases.
Outlets for family treatment
Pct of Pct of
Count Responses Cases
Government hospital 240 18.3 69.0
Private M.B.B.S. doctors 120 9.2 34.5
Quack/non-M.B.B.S. private doctors 348 26.6 100.0
Homeopath/Kabiraji/traditional healers 288 22.0 82.8
Religious/spiritual healers 288 22.0 82.8
NGO hospital 24 1.8 6.9
------- ----- -----
Total responses 1308 100.0 375.9
27. Among the interviewed respondents, all (100%) respondents described "low cost treatment" as the reason to select treatment outlets for the family members. Again 58.6% and 51.7% respondents described the reasons as "treatment facilities always available" and "nearer to the patient's house" respectively. About 44.8% respondents accounted for "treat with care and listen/counsel well" as the reason for the same. Here the factors influencing their choice of the service providers have been revealed.
-In the finding, the reasons related with the demand versus capacities for spending were describe by the service seeking rural population. Treatment costs, availabilities, counseling and the easier ways of approach etc. have been described by the beneficiaries as the indicators which they use to assess while go for a treatment to coup up with their own capacities.
Reasons to go to the outlets for family
Pct of Pct of
Count Responses Cases
Treatment/medicines are good 120 11.5 34.5
Low cost treatment/expenditure 348 33.3 100.0
Nearer to the patient's house 180 17.2 51.7
Treatment facilities always available/do 204 19.5 58.6
Treat with care and listens/counsel well 156 14.9 44.8
Others 36 3.4 10.3
------- ----- -----
Total responses 1044 100.0 300.0
28. Among the interviewed respondents, only 17.3% expressed their satisfaction in treatment wherever they get that. Curiously interesting is the finding is that, a vast majority of 82.8% remained "unsatisfied" with treatment, even in their outlets/hospitals of choice for the treatment of their family members! Here, the service seekers expressed their satisfaction/dissatisfaction in the service provided by any service providers. There are some factors causes their perceptions of client satisfactions.
-Only 17.3% of the respondents expressed their satisfactions in the treatment from anywhere they availed while diseased (they went in the service outlets where they could fit themselves in regards to the treatment costs and other factors!). It is interesting to note that about 82.8% respondents stated their dissatisfaction even after taking treatment in the outlets of their own choice! The mentioned satisfaction of the service seekers plays an important role in their health seeking behaviors and thus in their health care behaviors!
| Whether satisfied or not in treatment there | ||||
|
| Frequency | Valid Percent | ||
| Satisfied in treatment there | 60 | 17.24 | ||
| Not satisfied in treatment there | 288 | 82.76 | ||
| Total | 348 | 100.00 | ||
29. Among the interviewed respondents, 75.9% disclosed their reason for dissatisfaction as "Needs time to cure/can’t diagnose properly", whereas, 51.7% for "high fee", 41.4% stated their reasons of dissatisfactions for both "requires repeated visit" and "frequently prescribing injection/I.V. saline". About 31% described their reason for dissatisfaction as "bad behavior of the doctors and staffs of the hospitals".
Among the reasons for satisfaction, "see the patients with care" and "good treatment" accounted for 17.2% and 6.9% respondents respectively.
Factors causes their perceptions of satisfactions have been described here by the respondents. Those are again associated with many other factors .i.e. the factor "high fee of the doctors" is associated with financial capacity of the respondents to utilize his services.
-The respondents expressed their reasons for satisfactions and dissatisfactions which are directly related with their health care behavior. By careful following the reasons and the findings can be very efficiently utilized by keeping the reasons and their possible remedies in the mind during the health policy formation in different levels.
Cause of satisfaction/dissatisfaction
Pct of Pct of
Count Responses Cases
They see the pts. with care 60 6.1 17.2
Needs time to cure/can't diagnose prope 264 26.8 75.9
Requires repeated visit 144 14.6 41.4
Frequently prescribing injection/I.V. sa 144 14.6 41.4
High fee 180 18.3 51.7
Ordering costly pathologies 60 6.1 17.2
Behave badly 108 11.0 31.0
Good treatment 24 2.4 6.9
------ ----- -----
Total responses 984 100.0 282.8
30. Among the interviewed respondents, 93.1% believed the etiology of disease as "from the anger of Allah/God", whereas, 65.5% thought the etiology as "from infection by germs". About 41.4% informed of "other" reasons as the etiology i.e. "dissatisfaction of gods", "dissatisfactions of the nymph" etc. The factor like the traditional belief plays the major role in the context.
-Here, the findings show the extents of the resultants evolved through the dynamic interactions between the traditional beliefs of the population and the influences of the modern knowledge disseminated through different sources regarding the etiology (cause) of the diseases. Surprisingly, still 93.1% respondents stated the etiology as the "punishment from the Allah/God for sins". There are a large proportion of the respondents who believe that also the scheduled Gods/Goddesses and the nymphs are also capable of inflicting diseases to the human beings. It is still unclear to them about the mode of the transmission of the diseases but they thought that as a very complicated method, i.e. some respondents among them who believe in the mentioned "anger or dissatisfactions of the Allah/God or nymph", also believe in the infections by the germs (microorganisms). Their health seeking or care behavior will be thus dependent on the perceived etiology of the diseases!
Etiology of disease
Pct of Pct of
Count Responses Cases
Through bacterial/virus infection 228 32.8 65.5
From the anger of Allah/God 324 46.6 93.1
Others 144 20.7 41.4
------- ----- -----
Total responses 696 100.0 200.0
31. Among the interviewed respondents, 72.4% informed of providing first aids in home for patients, whereas, 27.6% informed of not providing first-aid in home. This is the community based resource playing role in need. These are the skills existing in the community and transferred to the next generation.
A large proportion of the respondents informed about the presence of the important health care behavior in the family diseases in their households, first-aid arrangements in the family.
| Whether providing first aids for diseases in home | ||||
|
| Frequency | Valid Percent | ||
| Providing first aid in home | 252 | 72.41 | ||
| Not providing first-aid in home | 96 | 27.59 | ||
| Total | 348 | 100.00 | ||
32. Among the interviewed respondents, 65.5% informed that the female chiefs of the corresponding families had supervised the family first aid. Only 17.2% informed that the male chiefs did it. Another 17.2% informed of the supervision by others like other family members etc. By tradition in Bangladesh, mothers usually are the caretakers in the family members’ sickness. The tradition passes from the mother to her daughter and skills are also transferred. This is an important community based participatory sustainable service option as the solution is available within the family or community. This is again the community resources. If limited modern skills can be infused in this level with modern information and the household level possible skill with the knowledge of effective referral, health hazards could be minimized to a great extent.
-Among the respondents informing their arrangements for family first aid, 65.5% respondents informed of the females in their households as family health care takers which signifies the importance of dissemination the health knowledge among the household females to achieve desired health care behaviors in a population. Traditionally in Bangladesh, specially in the rural areas, mothers, sisters and wives are the caretakers in almost all the places
| Supervising home treatment | ||||
|
| Frequency | Valid Percent | ||
| Supervised by female chief | 228 | 65.52 | ||
| Supervised by male chief | 60 | 17.24 | ||
| Others | 60 | 17.24 | ||
| Total | 348 | 100.00 | ||
33. Among the interviewed respondents, 93.1% expressed their beliefs in traditional/folk medicine, whereas, the rest 6.9% informed of their no belief in traditional/folk medicine. This reflects the important issue of the traditional beliefs and it causes people’s decision for the type of management they would seek for the illness of the family members.
-This finding expresses the strong traditional beliefs of the rural population on folk/traditional medicines. To bring positive changes in their health care behavior, this issues should be keenly considered with respect to indigenous and traditional practices and thus to introduce the modern practice or health care behavior with logics or instances in their own languages and through their own community people in a community based participatory way.
| Belief in traditional/folk treatment | ||||
|
| Frequency | Valid Percent | ||
| Believe in traditional/Kabiraji/country medicine | 324 | 93.10 | ||
| Not believing in traditional/Kabiraji/country medicine | 24 | 6.90 | ||
| Total | 348 | 100.00 | ||
34. Among the interviewed respondents, all (100%) respondents stated "green coconut water/ liquid /ORS/ laban-gur preparation (salt-molasses solution)" as the traditional/folk or indigenous treatment of diarrhoea, whereas, 93.1% respondents informed of the "holly water/talisman/exorcism" as the as the traditional/folk or indigenous treatment of diarrhoea. "Herbal extracts/herbs" accounted for 31%, whereas, unfortunately another 51.7% and 24.1% of the respondents opted for "heals spontaneously" and "closure of feeding" respectively indicating existence of potential grave public health risk in the issue still existing in the rural Bangladesh regardless the highly advertised optimistic views of government and many NGOs. These harmful practices evolve from the traditional beliefs of the population, although the lack of education and the financial conditions are also the factors to propel them towards such choices. Their knowledge for home fluids possibly the effects of the information dissemination community based field programs and media campaigns. -This finding shows the natural modifications of the traditional/indigenous health behaviors in the community by the dissemination of the modern knowledge. It is interesting to note that regardless all respondents’ believe in both traditional and modern remedy of "green coconut water/ liquid /ORS/ laban-gur preparation (salt-molasses solution)" for diarrhea (replenishing depleted body water and electrolytes), almost all them also believe in holy water/talisman or verities of exorcisms! We shall see later in this report the so called presence of influential Ola and Obba, the supernatural deities who were frequently blamed for the disease diarrhea in the rural areas as per the existing traditional myths!
Traditional/folk treatment for diarrhea
Pct of Pct of
Count Responses Cases
Green coconut water/liquid/ORS/laban-gur 348 33.3 100.0
Holly water/talisman/exorcism 324 31.0 93.1
Herbal extracts/herbs 108 10.3 31.0
Closure of feeding 84 8.0 24.1
Heals spontaneously 180 17.2 51.7
------- ----- -----
Total responses 1044 100.0 300.0
35. Among the interviewed respondents, 96.6% described "massaging warm oil/garlic-warm oil in chest" as the traditional/folk treatment for the respiratory infections including pneumonitis in the rural Bangladesh. About 72.4% opted for "ingesting tulsi/other herb extracts", whereas, 48.3% and 31% had opted for "drinking honey with or without hot water" and "eating onion-rice" respectively. About 10.3% opted for "spontaneous healing" signifying potential public risk in the disease still prevailing in rural Bangladesh.
Traditional beliefs, lack of education, lack of information and also the poverty etc. factors are responsible for their options for respiratory tract infections.
-The respondents informed about the various health care behaviors related with indigenous remedies for respiratory infections. But the important most issue is the 10.3% respondents, who informed about the spontaneous healing processes, which may result in grave conditions some times as the patients are not given any treatment.
Traditional/folk treatment of respiratory infection
Pct of Pct of
Count Responses Cases
Massaging warm oil/garlic-worm oil in th 336 33.7 96.6
Hot water drinking/gargling 96 9.6 27.6
Ingesting tulsi/other herb extracts 252 25.3 72.4
Drinking honey with or without hot water 168 16.9 48.3
Eating onion-rice 108 10.8 31.0
Heals spontaneously 36 3.6 10.3
------- ----- -----
Total responses 996 100.0 286.2
36. Among the interviewed respondents, it was curiously unveiled that 62.1% stated the traditional/folk treatment or remedy of RTI/STD as "coitus with virgin/fresh women"! Again 55.2% described "ingesting herbal extracts" as the traditional/folk treatment of RTI/STD, whereas another 69% had opted for "ingesting country elixirs (Saribadi salsa etc). Only 34.5% and 20.7% had been accounted for the more scientific approaches like "irrigating/washing genital organs with saline" and "drinking excess of water" respectively. However, 34.5% opted for potentially risky "heals spontaneously". These harmful knowledge are the results of partially the traditional beliefs, partially for the lack of the proper information in the RTI/STD in the rural areas. Here also the education, poverty and the prohibition of the information flow are the causative factors to retain this knowledge. When the issue becomes forbidden, imaginary information are usually added to that issue, fabrications are made. So, it is better to arrange a limited information flow in the community even on the most forbidden issue to avoid such harmful beliefs and to restrict malicious practices.
-This finding reveals some of the most interesting findings of this study. It is necessary to look after the health care behaviors of the population to design any fruitful and outcome oriented health policy but to do that with appropriate carefulness for the sensitive issues. However, community based strong participatory programs should be taken in right direction to diffuse the confusions and the malpractices in a community’s health care behaviors like the one as "coitus with a virgin to be cured from any venereal disease"! In no circumstances, that can be allowed, but the knowledge dissemination about the etiology and remedy of any venereal disease should be conducted with sufficient skills and through the respects to the indigenous good values of the community.
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