FACTORS ASSOCIATED WITH MOTHERS’ HEALTH SEEKING BEHAVIOUR ...

Fac. of Grad. Studies, Mahidol Univ. M.A.(Pop. & Repro.H. Res.) / 41

Mothers’ education affects their choice of care. Mothers who have no education
or only some primary education are much more likely than mothers with completed
primary education or higher to seek traditional healers or no modern treatment.
Contrarily, mothers who have complete primary education or higher have higher
probabilities of seeking modern treatment than other options.

Residence of mothers was not significantly related to their choice of treatment for
their children. Religion was not associated significantly level with mothers' choice of
care to treat children's diarrhoea. It is suggested that respondents, particularly the more
educated ones felt that beliefs and practices related to religion were old-fashioned.
However, it may be that practices regarding diarrhoea treatment based on religious belief
still exist. Further research to address this issue could be considered.

Regarding to knowledge of ORT, table 4 shows that mothers’ knowledge of ORT
is statistically significant affect their choice of care. The probability of seeking traditional
healers for mothers who have never heard of ORT is almost four times of mothers who
have ever heard of, or prepared ORT for their children’s diarrhoea. Vice versa,
probability of mothers who don’t have knowledge of ORT and seek modern treatment is
almost double the probability of mothers who don’t have any knowledge of ORT. These
findings highlight the importance of teaching mothers, who do not know about ORT, of
home treatment of diarrhoea as well as when and where to seek medical care if their
children's illness does not improve.

Jonas Sumampouw Findings / 42

Two other variables, accessibility of sources of care and children's sex, were not
statistically significant in affecting mothers' choice of care. Regarding the accessibility of
source of care, result indicates that although health facilities had been developed in
almost every part of Indonesia in order to decrease the distance of mothers’ residence and
the health facilities, it does not mean that easy to access to health facilities will affect
mothers’ decision making to manage their children’s diarrhoea by seeking a modern
treatment. Regarding sex of children, result indicates that sex of children is not an
important factor to be considered in mothers' health seeking care. In other words, there is
no difference in treatment by sex of child. However, it may be that in some areas,
practices based on sex preference, which determine treatment of any kind of sickness,
still exist.

Children’s age also explains mothers’ choice of care. For children under four years
of age, the younger the children are, the more likely mothers will seek modern treatment,
and the less likely that mothers will seek no treatment for their children’s diarrhoea.

Duration of diarrhoea in affects mothers' choice of care significantly. Children
who have diarrhoea for seven days or more are more likely to be taken to the modern
treatment and less likely that mothers will seek no treatment than children who have
diarrhoea for less than seven days.

Fac. of Grad. Studies, Mahidol Univ. M.A.(Pop. & Repro.H. Res.) / 43

The symptoms and signs of diarrhoea, that are recognized by mothers which
prompts them to seek care, have statistically significant relationship with mothers' choice
of care. Children who thirst, getting sicker or not getting better, are most likely to be
taken to seek modern treatment, comparing to children who have other signs and
symptoms. However, if children have fever, repeated vomiting, or repeating watery stools
with/without blood, they are more likely to be self-treated.

Jonas Sumampouw Discussion, conclusions and recommendations / 44

CHAPTER V
DISCUSSION, CONCLUSIONS AND RECOMMENDATIONS

5.1 Discussion
This study utilized children data file from The 1997 Indonesia Demographic and

Health Survey (IDHS, to assess the factors that are associated with mothers' health
seeking behaviour for treatment of their children's diarrhoea. By using Kroeger's model
(1988), to explain the process by which a sick person will select health care among the
choices available, this study has made an attempt to identify and examine the factors
which affect mothers' decision making in order to control their children's diarrhoeal
disease. Descriptive statistics and multinomial logistic regression analysis were utilized
to explain the mothers’ decision to seek care from four options, namely modern
treatment, self treatment, traditional treatment or give no treatment at all.

This study revealed that modern treatment was most frequently reported by
mothers as their choice of care, followed by no treatment, self-treatment and traditional
healer. This finding is similar with the result from the morbidity and case management of
diarrhoeal disease among mothers, which was conducted by Ministry of Health in 1993
(MOH, 1996). It indicates that mothers' health seeking behaviour has not changed

Fac. of Grad. Studies, Mahidol Univ. M.A.(Pop. & Repro.H. Res.) / 45

between the years of that survey and IDHS 1997. However, the most important
contribution of this study is that it showed that mothers' age, highest level of education,
children's age, duration of illness and mothers' perception of symptoms and signs as
significantly affect mother's choice of care.

Among the mothers’ characteristics, mothers who had no education were
significantly more likely than mothers who completed primary education or higher to
seek traditional healers. This result contradicts the previous studies, which mentioned that
education is not associated with mothers' decision making regarding treatment (Granich,
et al., 1999, Langsten, 1995, Emch, 1999), but congruent with Develay, et al. (1996), and
Feyisetan (1997). Education increases mothers' knowledge and their perception to
recognize the disease. It was expected that by having education, mothers could recognize
the severity of children's illness and then seek care from appropriate treatment, which is
modern treatment (Feyisetan, 1997). The result that mothers with no education or some
primary education were more likely to seek traditional healer is the same as Grace's
(1998) study. This could be because the majority of mothers who have low levels of
education reside in rural areas.

Mothers with low education are more likely to seek no treatment, or traditional
healers. Educated mothers are usually more likely to be exposed to current ideas than
less educated mothers and rural residents. Hence, educated mothers are more likely to
seek modern treatment. Thus, this study indicates that education plays a major role in

Jonas Sumampouw Discussion, conclusions and recommendations / 46

mothers' decision making to seek care for their children along with their knowledge of
ORT. Mothers with no knowledge of ORT are less likely to seek traditional healers than
modern treatment. This result suggests that educating mothers is essential in order to
increase their knowledge, especially knowledge of how to manage diarrhoeal disease at
the beginning.

The results also show that among children less than four years of age, the younger
they are, their mothers are less likely to seek no treatment or self treatment, and more
likely to seek modern treatment. This result indicates that mothers know when and where
to seek care for their infants' diarrhoea.

5.2 Conclusion
Decisions to seek outside health care is primarily undertaken by mothers. The

objective of this study was to identify factors associated with mothers' health seeking
behaviour to control their children's diarrhoeal disease. Furthermore, the results of the
study provided inputs, which can be used by programmes to improve their performance,
so that goals to reduce child mortality due to diarrhoeal disease can be achieved. Data
from the 1997 Indonesia Demographic and Health Survey (IDHS) were analyzed. A total
of 1,603 children in 27 provinces in Indonesia who had diarrhoea within two weeks prior
the interviews were studied. The mother's choice of care for their children's diarrhoeal
disease, such as modern source of care (health facilities or health providers), buying

Fac. of Grad. Studies, Mahidol Univ. M.A.(Pop. & Repro.H. Res.) / 47

medicines from pharmacies or shops for self treatment, going to traditional healers, or
giving no treatment was determined.

Multinomial logistic regression was used to assess the factors affecting choice of
care. The findings revealed that of the eleven independent variables, age of mothers, level
of education, mothers' knowledge of ORT, age of children, duration of diarrhoea, and
symptoms and signs of diarrhoea were statistically significantly affecting mothers' choice
of care. These factors influence whether they will bring the children to a modern
treatment source (health facilities or health providers), administer self-treatment, go to
traditional healers, or give no treatment at all. Other variables such as mothers' place of
residence, mothers' labour force status, mothers' religion, mothers' accessibility of source
of care and children's sex were not found to be significant.

This study revealed that seeking care from a modern treatment was most preferred
by mothers to treat childhood diarrhoea (54 per cent) followed by giving no treatment (23
per cent), administering self treatment (19 per cent) and seeking care from a traditional
healer (5 per cent).

The results also show that among children less than four years of age, the younger
they are, their mothers are less likely to seek no treatment or self treatment, and more
likely to seek modern treatment.

Jonas Sumampouw Discussion, conclusions and recommendations / 48

Practices to buy medicines from pharmacies or shops to administer self-treatment
were the second popular option, particularly for mothers who lived in urban areas.
However, it is surprising that mothers who were not working preferred this option.

This study found that traditional healers would more likely to be sought when
mothers are older, have less education and the duration of illness is less than one week.
However the probability of mothers to seek traditional healers is small.

5.3 Recommendations
In view of the findings of the study, the following recommendations are made to

accelerate the goals of the diarrhoeal disease control program in Indonesia.
(1) The older mothers should be emphasized as the target group for dissemination of

information about health education, particularly about how to prevent the diarrhoeal
diseases and to obtain prompt treatment if the diarrhoea continues for two days or
more. The dissemination of information intended should include the importance of
the first action that mothers should take, which is giving oral rehydration therapy
(ORT) instead of buying medicine that is harmful for the children. It is important to
teach mothers not only how to use ORS or ORT but also how to identify signs of
dehydration and to seek timely medical care. Mothers must be taught to identify early
symptoms of dehydration. A significant weakness of the existing programmes is that
they are not intended to teach mothers how to recognize the signs and symptoms of
dehydration, or to look for medical care when needed.

Fac. of Grad. Studies, Mahidol Univ. M.A.(Pop. & Repro.H. Res.) / 49

(2) Since 18 per cent of mothers buying medicines from retail pharmacies and shops to
administer self-treatment are the third options of their choice of care this problem
should be addressed. The influenced of products sold and advice given to customers
by drugs sellers might be the factors that affect mothers’ health seeking behaviour.
Using training interventions to change the practices of pharmacist along with their
employees as well as the drug sellers should be given consideration. Lack of
knowledge and skills in one of the main reasons why drugs sellers act as they do.
Thus training which changes knowledge and skills can itself change behaviour, at
least initially.

Jonas Sumampouw Bibliography / 50

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