UNIVERSITY OF IBADAN LIBRARY ENDER & EHAVIOUR Volume 10 No 2, DECEMBER, 2012 Published by:Ife Psychologl A (RC 011934) Ife Centre for Psychological Studies/Services. P.O. Box 1548, 1le-Ife Osun State, Nigeria. & The Network of Psychological Studies of Women Issues Department of Psychology University of Ibadan Ibadan. UNIVERSITY OF IBADAN LIBRARY Volume Ten ISSN 1596-9231 Number Two CONTENTS December, 2012 NAME OF AUTHORS TITLE OF ARTICLES EDITORIAL i CONTENTS iii GLADYS MATSEKE, KARL 4627 Correlates of Condom Use among PEL TZER, GUGU MCHUNU, & Male and Female aged 18-24 Years JULIALOUW in South Africa. ~I.E. HOQUE, T. NTSIPE, & M. 4645 Sexual Practices among University MOKGATLE-NTHABU Students in Botswana. SUNDAY OLUSOLA ALUKO- 4657 Exclusive Breastfeeding in the AROWOLO & JAMES Contexts of Socio-Cultural ADENIYI ADEKOY A Challenges and Mothers' Health in Rural and Mixed Urban Areas of . Ijebu, South Western Nigeria. GIROH, D. Y., JOYCE D. 4678 Analysis of the Factors Influencing MOSES., BALOGUN, F. E., & the Technical Efficiency of Women ODEKINA, F.O Rubber Tappers in the Rubber Belt of Nigeria. E. FABUSORO , G. O. SOKOYA, 4687 Gender Analysis of Production O. S. AYORINDE, C. I. System and Decision Making in ALARIMA AND 0.0. Fulani Agro-Pastoral Households in ODUGUWA Southwestern Nigeria. JAN WIlD & MICHAEL CANT 4712 Female Spectator Satisfaction and Perceived Service Quality on University Sporting Grounds. ENNA GUDHLANGA & CHIPO 4732 Are We Not Beneficiaries Also? ·CHIRIMUUTA. Portrayal of Gender and Land Reform in Davie Mutasa's Sekai Minda Tave Nayo. iii UNIVERSITY OF IBADAN LIBRARY OGBOGU CHRISTIANA 4751 Gender Issues in the Recruitment and OSAIKHIUWU, & BISIRIYU Selection of Academic Staff in a LUQMAN ADELEKE Nigerian University. KEHINDE O. AYENffiIOWO, 4767 Young Adults Perception of GABRIEL A. AKINBODE, Appropriateness of some FOLUSHO AYODEJI, & DomesticlHome-Related Activities: TEMITAYO D. ADEWUYI Implications for Gender Role Acquisition. ONABANJO OLUWASEGUN 4792 Dying along the Ladder of DAVID & NWOKOCHA Stratification: A view of Rural - EZEBUNW A. E. Urban Dichotomy In Malaria Treatment among Pregnant Women in Ondo State. HUMERA JAMAL, 4815 Cultural Saga: Does Pakhtun Culture MUSSA WAR SHAH, SIDRA Impede Women Employment? IQBAL, ASAD ULLAH & IMRAN THOMAS MUPETESI, JOSEPH 4832 Gendered Patterns of Social Capital FRANCIS, RICHARD GOMO & among Farmers in Guruve District of JOHNMUDAU Zimbabwe. LOUISE VAN SCHEERS, 4849 The Correlation between Cherry MC CANT & JAN WIlD Picking Female Consumers and Product and Price Knowledge when Buying Groceries in Tshwane, South Africa. CHRISTABELLE S. MOYO, 4864 Grassroots Communities' Perceptions JOSEPH FRANCIS, & Relating to Extent of Control as A PRINCIP AL NDLOVU Pillar of Women Empowerment in Makhado Municipality of South Africa. LINGESPERI NAIDOO, 4883 The Leadership Behaviour of the NITHI MUTHUKRISHNA, & School Principal: An Exploratory SALLY HOBDEN Study in Five Special Schools in Kwazulu-Natal. iv UNIVERSITY OF IBADAN LIBRARY D CHETTY, & ME HOQUE. 4914 Effectiveness of a Volunteer-Led Crafts Group Intervention amongst Mild to Moderately Depressed Indian Women ill KwaZulu-Natal, South Africa. EDGAR H. TYSON 4926 Do Males And Females Report ALICIA MCLAUGHIN Similar Constructs to Rap Music? A Cross-Gender Validity Study of the Rap Music Attitude and Perception Scale. GE CHILOANE- TSOKA 4949 Cultural Observations Facing Women Managers: A South African Perspective BOLANLE OGUNGBAMILA 4974 Influence of Gender and Psychological Violence on Physical Violence Among Employers III South-western Nigeria. QUINTER MIGUNDE, 4987 Gender Differences, Career PROF JOHN AGAK, Aspirations and Career Development DR. WYCLIFFE ODIWUOR Barriers of Secondary School Students in Kisumu Municipality BAKARE,AVEEZ 4998 Meaningful Causal Model among OLUWATOYIN Psycho-Sociological Factors on psychological Well-being of the Hearing Impaired Adolescents in Southwest, Nigeria. CHARITY AKOTIA 5022 The Moderating Effects of Age and Education on Gender Differences on Gender Role Perceptions. Abstracting & Indexing 5045 PsycINFO Journal 5046 Ulrich International Directory 5047 Reach Us 5048 v UNIVERSITY OF IBADAN LIBRARY Sabinet Online 5049 Invitation to Subscribe 5050 Communication with the Editors 5051 Ife Psychologia (RC LAZO 11934) 5052 Ife Psychologia 5053 African Journals Online 5054 vi UNIVERSITY OF IBADAN LIBRARY Gender & Behaviour, 10(2), December 2012 Copyright © Ife Center for Psychological Studies/ Services, Ile-Ife, Nigeria Dying along the Ladder of Stratification: A view of Rural - Urban Dichotomy in Malaria Treatment among Pregnant Women in On do State. ONABANJO,Oluwasegun David* Department of Sociology Faculty of the Social and Management Sciences Olabisi Onabanjo University, Ago-Iwoye, NWOKOCHA,Ezebunwa. E. Department of Sociology . University of Ibadan, Ibadan Abstract Studies on malaria related maternal mortality in Nigeria have focused largely on preventive behaviours and healthcare provide,s' knowledge of treatment regimen. However, negligible attention has been paid to rural - urban differentials and treatment patterns adopted by care seekers in relevant contexts. This study, therefore, investigated the factors that influenced pregnant women's disposition to malaria treatment in rural and urban areas of Ondo state. The Health Belief Model, Theory of Planned Behaviour and Health Utilization Model were used as the theoretical framework. The study employed descriptive survey research design using both quantitative and qualitative data collection techniques. Quantitative data were collected from 927 respondents selected through a multistage sampling technique in 10 Local Government Areas of the state. Qualitative data were elicited from six Key Informant Interviews (KIIs) conducted with Modern and Traditional health providers selected from the list of care providers in each LGA.The quantitative data were analysed employing descriptive statistics, chi-square, T- test and Ordinal Regression, while content analysis was used for the qualitative data . • oluwasegundavid@gmail.com; 08058056556, 08099515232 - 4792- UNIVERSITY OF IBADAN LIBRARY Gender & Behaviour, 10(2), 2012 Mild malaria were treated at home while severe cases were referred to formal health care, however moderate difference existed in rural (X=1.52, SD=0.49) and urban (X=1.29, SD=0.45) respondents' choice of treatment options. More urban men than their rural counterparts provided respondents first treatment for malaria. Rural respondents (20.90/0) than their urban counterparts (19.7%) reported drug failure in their first treatment regimen. . Malaria treatment was influenced by socioeconomic and demographic factors both at rural and urban areas of the state. POlicy and national programmes aimed at reduction in maternal mortality should recognise .the cultural milieu given its linkage with the aetiology of disease. Without a deliberate intervention, malaria induced maternal morbidity and mortality will remain high not only in Orido State but Nigeriain general. Keywords: Rural-urban Dichotomy, malaria treatment, maternal mortality, Ondo State. Introduction Improvement in maternal health, reducing child mortality and combating malaria related morbidity and mortality (MMM) are fundamental in Millennium Development Goals (MDGs). These areas are still major concern in sub-Saharan Africa. Maternal Mortality Rate (MMR) in Africa is the highest among other continents of the world; this is estimated at about 1000 deaths per 100,000 live births (NewPartnership for African Development, 2008). By implication, 1 in 20 African women dies of pregnancy related conditions compared with 1 in 4000 women in Europe (NEPAD, 2008). Malaria contributes substantively to the increasing deaths of women, that is why the disease is regarded as a public health problem in the continent. (WHO, 2010) Factors associated with increasing MMM include poverty, social excltrsion , marginalisation, inadequate or lack of sanitation and lack of standard health care system among others. Malaria in Nigeria is responsible for over50% out-patent attendances and 400/0 of hospital admissions, it is a major cause of infant and maternal mortality, at least 500/0of the population suffer from at least one episode of malaria each year (Jimoh:2009). The consequent effects of these maternal health challenges in Africa have undermined social and economic development in relevant communities, more so, that health of expectant mothers - 4793- UNIVERSITY OF IBADAN LIBRARY Onabanjo, O. D. & Nwokocha, E. E.: Rural-Urban Dichotomy in Malaria Treatment and their unborn babies are crucial both as reflection of health status of a large segment of the population and as predictors of health of the next generation (Mba:2006, Asante & Asenso- Okyere:2008). Nigeria Demographic and Health Survey -NDHS- (2008) estimates suggested that women in reproductive age 15-49 comprise 44.7% of the population while their male counterparts were 42.1%. Protecting the health of this large population in the views of Mba, 2006 is an investment in the labour force which is synonymous with wealth of the future. In April 2000, representatives of International' Health and Development Organizations and African Heads of State met in Abuj a, Nigeria, and inaugurated "Roll Back Malaria" programme targeted at reducing the global burden of malaria. Ever since then, NDHS (2008) reported that only 7.6% of women aged 15-49 (3.60/0urban and 4.0 rural) slept under ITNs. The situation has contributed to malaria prevalence among this group of women in Nigeria. Also, socio-cultural, economic and environmental factors such as education, income, housing patterns, social groups, water storages and treatment seeking behaviour play significant roles in the transmission, prevention and treatment of malaria (Anumudu et al 2006). Despite increasing efforts on malaria control in Africa, little achievements could pe shown for this (WHO: 2010). In view of increasing rate of MMM in Nigeria, achievement of the MDGs for reducing under-five mortality by two-thirds between 1990 - 2015 and' improvement in maternal health through reduction by three- quarter the maternal mortality rate is much more difficult. When women die from malaria related diseases, the health of their child(ren) is affected and because these women are in their productive and reproductive years, their deaths have tremendous adverse irnpact on family economy and the society at large (MbFJ_:2006)H. usbands to these women are likely to re-marry after the deaths of their wives and continue childbearing, thereby increasing fertility rate in the country. Death of a family member has a psychological implication on the wellbeing of other family members who might not be able to engage in any productive activities for a period of time. Decisions on choice of care, influence of kinsmen on care pattern among other socio-cultural factors are crucial in understanding treatment patterns for malaria especially during pregnancy (Isiugo-Abanihe; 2003, Erinosho; 1998, Agbonlahor; 1995). Medical care for malaria in Nigeria is delivered in a variety of settings ranging from modern/orthodox to traditional/indigenous. - 4794- UNIVERSITY OF IBADAN LIBRARY Gender & Behaviour, 10(2), 2012 Patents' choice of care in any of these institutions is based on their perceived etiology of the disease among other factors (Alliyu and Oduwole; 2005). In Ondo state, there is a widespread of these health institutions concentrated mostly in urban areas. In rural areas and riverine communities, formal health institutions are practically not available. These have resulted in proliferation of Traditional and Faith Birth Attendants along with Patent Medicine Store operation in the area. The implication is that some of the care givers lack adequate training in treatment of ITlalaria ., in pregnancy. Also, crucial on pathways to care is the interaction of multiple other variables such as socio-cultural factors like beliefs and household decision making to seek care, social networks, gender and time to care centres. In Nigeria and other African nations, health system remains weak and cannot respond to health needs due to inadequate skilled care providers, lack of equipments, medicine and supplies; an inefficient referral system, staff were not always friendly, there is high attrition rate among skilled personnel including Doctors, Phamacists, Nurses and Midwives, and lack of both institutional and human capacity to manage maternal health (Luanniale and Rajais :1996,Batega. 2004, Mba;2006). All these variables have maintained a noted influence of malaria treatment in pregnancy, thereby, contributing to its complications. Ondo State like other states in Nigeria has challenges on developmental indices. These have a notable impact on their health facilities which are in a poor state coupled with non availability of drugs and the negligible number of medical personnel to cater for the growing population. While malaria accounts for 11% maternal mortality in Nigeria (WHO, 2010), in Ondo state malaria related mortality increased from 9 in 2004 to 43 in 2005 (FMOH, 2005) making the state the highest contributor to malaria mortality statistics in South West Nigeria. It is on above issues that this study seeks to examine rural-urban dichotomy in malaria treatment among pregnant women in Ondo state. Methodology Both quantitative and qualitative methods were adopted in data collection. Methods used for qualitative methods are In-depth interviews and Exit interviews while a structured questionnaire was adopted as quantitative technique. Breakdown of the Local Government Areas (LGAs)engaged in the study is presented in table 2. Table 2: List of selected Local Goveenmerrt Areas - 4795- UNIVERSITY OF IBADAN LIBRARY Onabanjo, O. D. & Niuokocha, E. E.: Rural-Urban Dichotomy in Malaria Treatment LGAs Nature of LGAs 1 Akure South Urban 2 Akoko North-East Urban 3 Odigbo Urban 4 Okitipupa Urban 5 Ondo West Urban 6 Owo Urban 7 Ilaje Rural 8 Ese-Odo Rural 9 Ile OlujijOkeigbo Rural 10 Ose iI. Rural ,, , Study Population: The population of the study. comprised pregnant women in different trimesters that had been diagnosed for malaria and were seeking care in health facilities. Sampl~ size and Sampling Techniques A combination of methods was adopted for selection of samples for this study. Ondo State has 18 Local Government areas (LGAs) ; (11 urban and 7 rural). The LGAswere stratified according to their size and nature (rural or urban). 6 urban and 4 LGAs representing 5CY%were selected from each category through Simple Random Sampling. Lists of registered health centres and Traditional/Faith Birth Attendants (TBAs)available in each of the selected LGAs were obtained from the State Ministry of Health. This provided the sample frame for health facilities selection. However, non registered facilities like Patent Medicine Vendors (PMVs)were included particularly in rural and riverine areas of the state. Pilot study revealed that these facilities were prominent in rural areas of the state than the urban. Purposive sampling method was adopted in selection of 34 health facilities ( 20 Orthodox care centres, 8 T IFBAs, 6 PMVs)for the study. In line with this, specializations in each of these centres were taken into consideration during selection process. Pregnant women in different trimesters seeking care for malaria were selected from the chosen care centres in each of the selected LGAs through accidental sampling. This method was adopted because all expectant mothers were not present in all care centres at the same time, even during antenatal days some were absent. - 4796- UNIVERSITY OF IBADAN LIBRARY Gender & Behaviour, 10(2), 2012 All available pregnant women diagnosed for malaria and receiving treatment at the time span of the fieldwork were selected. A total of 927 women in this category across the selected health care centres participated in the study. Data collection spanned a period of six months. Inclusion criteria; The inclusion criteria for respondents in this study were: Respondents must be pregnant, Diagnosed for malaria and Receiving treatment in any of the treatment centres selected for the study Methods of Data Collection In-depth Interviews (IDI)- Orthodox health providers, Patent Medicine Vendors (PMVs), Traditional Birth Attendants (TEAs) and Faith Healers were key informants for the study. The lists of these care providers (orthodox and traditional) in each LGAs were obtained from their secretariats and the following selected from each LGA through Simple Random Sampling 1 medical Doctor, 1 Midwife/ Nurse, 1 TEA, 1 Faith Healer, 1 Patent Medicine Vendor, 1 religious Leader. Across the selected LGAs, Key Informant totalled forty (50) and the breakdown is as follow: 10 Medical Doctors, 10 Midwives/Nurses, 10 Faith/Traditional Birth Attendants, 10 Patent Medicine Vendors (PMVs).10 Religious Leaders The IDI discussion guide was designed based on objectives of the study. Each question was supported with relevant probes questions. The selection of these Care givers was done to buttress possible claims of the respondents in those areas. Questionnaire A structured questionnaire was the main research instrument used for the collection of primary data from the pregnant women. The questionnaire was pre tested to ascertain its validity. The questionnaire sought to gather the following data: dem-ographic and socio-economic characteristics of respondents' households, Pregnancy duration and frequency of malaria morbidity, direct cost of a malaria episode to the household (out- of-pocket expenses), indirect cost in the form of productivity lost by malaria patents, caretakers and substitute labour, access arid use of maternal health care facilities. Questions on the questionnaire were built around the objectives for the study. Data Analysis Qualitative Data: Qualitative data emerged from and was analysed through content analysis. Tapes and notes from In- depth Interviews were first translated and transcribed. Comparison with field notes was done to ensure no loss of - 4797 - UNIVERSITY OF IBADAN LIBRARY Onabanjo, O. D. & Niookocha, E. E.: Rural-Urban Diclwtomy in Malaria Treatment information. This became necessary as both English and Yoruba languages were used in the process of data collection. Qualitative data were then coded according to the coding guide for a preliminary assessment of the translated scripts using open code software package for qualitative data analysis. Quantitative Data: Questionnaire for the study was first sorted as those not properly filled were removed. To minimise errors, data from questionnaire were coded and edited before entry into the SPSS - Statistical Package for Social Sciences- software. Univariate, bi-variate, cross-tabulation and rnultivari ate methods of analysis were adopted for quantitative data. Statistical methods adopted in data analysis are presented in table 2 Limitations of the study The major limitation is that Orido state is a multi-cultural society where there are variations in cultural practices, belief system and dialect of the people. This has serious implications on health seeking behaviour and generalisation among them. It became expedient to rely on variables that cut across different cultural groups in the state. The implication is that generalization and deductions with regards to thematic issues could not be accurately made in order not to face what Nwokocha (2004) described as danger of invalidation by subsequent data. Pregnancy has ability to influence women's dispositions and behaviour, conducting a study among this group of people has series of behavioural challenges. Some of these women are already overburdened with pregnancy cum malaria, therefore responding to questionnaire was like an additional task or burden, while some responded cheerfully, others were hostile and in the process, many questionnaires were not completed. Interventions of the care providers were very significant as earlier permission and their cooperation were sought. They acted as middle men in appealing to these women before questionnaires were administered on them. While the respondents were waiting for treatment at their various care centres, biscuits and soft drink were provided hence they would have rushed home immediately they were attended to by their health providers. At some TBAs and FBAs, several visits were made as these people declined consent despite approval from the state government. The hostility was strong relating to the fact that the researcher is not an indigene of the state. A guide which was known to every member of the community was engaged from each community the study covered and a payment of N4,OOO($26 at N154j$ the exchange rate during the study) paid per community. - 4798- UNIVERSITY OF IBADAN LIBRARY Gender & Behaviour, 10(2}, 2012 Findings and Discussion Table 1: Demographic Characteristics of the Respondents Characteris tics Categories Rural (%) Urban (%) Total (%) Age 15-19 5.3 6.4 1l.7 20-24 5.4 8.6 14.0 25-29 15.5 27.8 43.4 30-34 10.2 13.8 24.1 35-39 4.0 l.4 5.4 40+ l.4 - l.4 Total 41.9 58.1 100 Religion Christianity 34.7 46.6 81.3 Islam 5.6 1l.6' 17.2 Traditional 1.4 0.1 1.5 TOTAL 41.7 58.3 100 I Education No formal education 0.9 0.2 l.2 Primary education 7.5 9.9 17.4 completed 0.8 l.0 1.8 Junior school completed 16.7 31.2 47.9 Senior school completed 14.7 17.0 31.6 Higher education 40.6 59.4 100 TOTAL 2.6 3.8 6.4 Single 32.6 50.1 82.6 Married l.5 0.8 . 2.2 Separated 3.9 2.8 6.6 Marital Status Cohabiting 0.4 0.1 0.5 Divorced l.1 0.4 1.5 Widowed 42.1 57.9 100 TOTAL Civil service 10.4 12.8 23.1 Farming 5.6 3.2 8.8 Trading 14.6 26.5 41.0 Occupation Artisan 2.9 10.5 13.4 Unemployed 4.0 9.6 13.5 TOTAL 37.5 62.5 100 .J.V(""j, ""v .•.••• self-medicate as a pattern of treatment is more convenient, easy, less costly, and saves more time than formal treatment and also Patients often feel that health workers are too busy and may become impatient if they ask for clarification on drug use or need clarification on health issues considered vital. To Foster, User charges for services and/or drugs is becoming increasingly more common in developing countries and this poses an economic barrier to antimalaria treatment at formal health services. Self medication in malaria' treatment is a' more common phenomenon among urban respondents than their rural counterparts (22.7% v 10.2%). Modern health care services constitute the second largest sources of treatment. Health centres and hospitals are likely to act as referral points where home treatment of malaria fails. This practice is more common in urban areas of Ondo than their rural areas, where Mission houses and Nurses in the Neighbourhoodsplay significant roles. The significance of Mission houses in Health Care Delivery System of Ondo state can be accounted for with what Robert, K Merton in his Structural Functionalism theory regarded as 'Postulate of Indispensability'. By this, Merton pointed out that an alternative structure (MissionHouses) can exits to fulfil basically the same function or part: of functions in other structure (Health Care) of the society. This functional role is described as 'functional alternatives' or 'functional equivalents' and 'functional substitute' of a structure. (Turner,1978). It should be noted that apart from religious activities engaged by Christian Missionaries in Ondo State, Health care Deliverysystem particularly antenatal and post natal care are also encapsulated in their assignments a function that can be described in the word of Merton as 'Latent'. This role has increased over the years judging by increasing attendance of pregnant women in most of these mission houses particularly where government functional hospitals are not available or health workers are perceived not to be friendly. Ayanleke (2011) attributed increasing patronage of these centres to available care pattern which are both spiritual and medical. It is important to note that pregnancy and choice of care in Yoruba culture is spiritually constructed and interpreted, it is then not out of place when spirituality is engaged in care seeking for diseases during same. Among respondents from both rural and urban areas in Ondo State, men appear to be knowledgeableabout malaria treatment in pregnancy as respondents claimed they acted as their first source of treatment. This, however, is more common among urban respondents (11.6%)than their rural counterparts (10.8%): - 4805- UNIVERSITY OF IBADAN LIBRARY Onabanjo, O. D. & Niookocha; E. E.: Rural-Urban Dichotomy in Malaria Treatment Societal structure and Individualitywhich dominated ways of life in urban areas compared to communal affinity in rural community gave room for others within the community to provide care alongside the husband and other members of the family (Fadipe, 1991). A better understanding of Fadipe's observation is noted from. the table, if other sources of treatment in both rural and urban areas like biologicalmothers (2.8%) v 3.8%), mothers- in-law (1.10/0 v 3.5%) and Mission Houses (0.5% v 1.40/0) are examined. Rural respondents than their urban counterparts adopted multiple methods in their treatment of malaria. It becomes necessary to document respondents' timing in care seeking and this is presented in figure 2 below. r===~~====~~~==~~==~~~==~~ .nant Women in Ondo State Urban • Immediately • two or more days later Rural I ~-----'----~------'--.----,---I 0.0% 20.0% 40.0% 60.0% 80.0% Percent Source: Field survey 2011 The majority (78.10/0) of pregnant women in urban areas of Ondo state did not seek immediate care in the treatment of malaria like their counterparts in rural areas of the state. This indicates that care is sought in urban area when malaria morbidity persists for more than a day. This observation is in line with Nyamongo - 4806- UNIVERSITY OF IBADAN LIBRARY Gender & Behaviour, 10(2),2012 (2002) that people seek to mmirmse expenditure incurred on malaria treatment by starting with self-treatment at home and observing progress before making a decision to seek care elsewhere. Theoretically, the respondents' perception of seriousness of the disease. as illustrated in Health Belief Model play vital role between commencement of the disease and time of care seeking. This could also be connected with the perceived behavioural control in terms of access to resources need to act successful as Ajzen and Fishbein (1980) noted in their Theory of Planned Behaviour. Qualitative data revealed that malaria is perceived as a natural disease resulting from strenuous work, too much consumption of palm oil, lack of adequate rest and over exposition to sunlight. However, when treatment lingers longer than necessary, causes of malaria among pregnant women could be attributed to spiritual and sin as such treatment is sought outside the modern healthcare facilities. This is noted from the view of one of the Primary Caregivers in rural area of the state. When we do all we know to do yet the sickness persists we then have to consult the gods for ways-out and appeal to gods for forgiveness of sins where need may arise. (Female IDI, Igbokoda LGA). The views on aetiology of disease in rural areas are contrary to that of the urban care givers who attributed malaria morbidity to biomedical explanation. These constructions on aetiology of this disease have resulted into variation in care seeking and treatment. behaviour among pregn~t women and their care providers. Table 6: Percentage Distribution of respondents' reasons why care was sought when it was sought, by respondents' place of residences (N=927) Place of Why care was sought late Total Residence (%. Husband There Initial Nobody Treatment Don't not at was no drugs to assist centre is know home money failed (%. far (%. (%. (%) (%) (%) Rural 7.4 3.2 20.9 1.8 5.3 7.4 45.9 Urban 8.2 7.9 19.7 2.4 2.6 13.2 54.1 Total· 15.6 11.2 40.6 4.1 7.9 20.6 100 Source: Field survey2011 In both rural and urban areas of Ondo State, men play significant role in health seeking behaviour of their households; they are major makers of decisions in the family and by extension on health issues of every member of the family. This is noted in care seeking behaviour of most of the pregnant women in both rural - 4807- UNIVERSITY OF IBADAN LIBRARY Onabanjo, O. D. & Nwokocha, E. E.: Rural-Urban Dichotomu in Malaria Treatment and urban areas of the state. Moreof urban respondents (8.2%) than their rural counterparts (7.4%) attributed their late entry into treatment to non availabilityof their husbands. The situation is expected to be different in urban areas of the state where women empowerment, economic independent, education attainment and technological advancement are higher, but reverse is the case. Fishbein & Ajzen (1980) in their theory of Planned Behaviour described these women's behaviour as being guarded by subjective norms- a belief in whether relevant persons such as husband will approve ones' behaviour. Isiugo-Abanihe (2003) attributed these women's behaviour to significance of male in African society which is encapsulated in cultural practices made possible through socialisation where every society prescribes appropriate roles for male and female. To him, this idea has. restricted women's access and control of-means of production and .reproduction, provides the principles for women subordination where women are to respond to men leadership position in the family rather than initiating their ownideology. Data from Table 6 revealed that more urban resporidents (7.9%) than their rural counterparts could not seek immediate care for malaria due to lack or financial capabilities. This figure doubles those women in rural (3.2%) areas who had similar challenges. Rural women are more likely, than their urban counterparts, to have access to loans and credit facilities from their healthcare givers. The. financial status of Ondo women and their health seeking behaviour ·can be explained within the Health Belief Model of Rosenstock as a barrier to action taken among these wornen: In a similar reaction, Raj (2005) in a study on health seeking behaviour ·ofwomen in Uttar, Pradesh, India discovered that women are not financially strong likemale counterparts, and this disadvantageous position play significant roles in their health seeking behaviour. Raj observation is closely associated with Orido' women's care seeking for malaria particularly when costs of transportation and other intangible costs are considered. A majority (40.6%) of the expectant mothers attributed failure of initial drug to their late entry into re-treatment milieu. More respondents (20.9%)in rural areas than their urban counterparts (19.7%) reported drug failure in their initial treatment regimen. This phenomenon had been responsible for challenges in eradicating the disease which by extension has led to increase in its morbidity and mortality in Nigeria. Summary of Findings, Conclusion and Recommendation - 4808- UNIVERSITY OF IBADAN LIBRARY Gender & Behaviour, 10(2), 2012 The study found out that: 1. Rural women are more likely, than their urban counterparts to adopt multiple methods in their treatment of malaria. 2. that views on aetiology of disease in rural areas are contrary to that of the urban care givers who attributed malaria morbidity to biomedical explanation. These constructions on aetiology of this disease could have resulted into variation in care seeking behaviour among the respondents. 3. in both rural and urban areas of Ondo State, men play significant role in health seeking behaviour of their households. They are major makers of decisions in the family and by extension on health issues of every member of the family. This is noted in care seeking behaviour of most of the pregnant women in both rural and urban areas of the state. 7.4% rural and 8.2% urban respondents attributed their late entry into treatment to non availability of their husbands. 4. there were more poor pregnant women in urban areas of Ondo State than rural areas. 5. health centres and hospitals are likely to act as referral points where home treatment of malaria fails. This practice is more common in urban areas of Ondo State than their rural areas, where Mission houses and Nurses in the Neighbourhoods play significant roles. 6. treatment ofmalaria in the study area usually commences with self medication. This is more common phenomenon among urban respondents than their rural counterparts (22.7<%v 10.2%). .' 7. in some rural areas, there are no functional government hospitals, as such Patient Medicine Store practitioners and Traditional/Faith Birth Attendants are primary care givers Malaria burden and maternal mortality reduction strategies in Nigeria must be anchored on cultural construction of reality otherwise, attainment of the MDGscould be far from attainment. The study recommends; 1. A growing need for improvement in women' educational status, particularly, in the rural areas of Ondo State through adult literacy programmes. This becomes - 4809- UNIVERSITY OF IBADAN LIBRARY Onabanjo, O. D. & Nwokocha, E. E.: Rural-Urban Dichntomy in Malaria Treatment imperative in view of the fact that women's educational status in Ondo state is low. This becomes necessary as status and health of women could be better enhanced through qualitative education. 2. The need for various levels of government to provide health care facilities particularly in rural and riverine areas of Ondo State cannot be over stated. This becomes necessary as referral process is hampered by difficult terrains where people in these communities are residing. They also occupy areas that are disadvantageous with almost all social amenities lacking. In line with this, a separate policy addressing health care in rural areas should be put in place different from that of the urban areas. 3. Rural communities in Nigeria have not shown any significant benefits from the National Health Insurance Scheme (NHIS)In line with the above, there is a need for extension of this policy to informal rural sector if maternal and child health will be improved in Nigeria. - 4810- UNIVERSITY OF IBADAN LIBRARY Gender & Behaviour, 10(2),2012 References Agbonlahor, F.r. 1995. The Determinants of Maternal and Child Health care Decisions in Edo State, Nigeria. An Unpublish?d Ph.D Thesis submitted to the Department of Sociology,University of Ibadan, Ibadan. Asante, F. A. and Asenso-Okyere, K,. 2008. 'Economic Burden of Malaria in Ghana'. World Health Organisation (WHO). Ajzen, I. and Fishbein, M. 1980. Theory of Reasoned Action available at en.wikipedia.org Alliyu, N and Oduwole, M.2005. Hospital and Quality of Care: Implications For Health Development in Nigeria. In Ago- Iwoye Journal of Social and Behavioural Sciences Vol. 1 No 1 88-102. Anumudu, C.I,. Adepoju, A,. Adediran M,. Adeoye,0,. Kassim, A., Oyewole, I, and Nwuba, R.I,. 2006. 'Malaria Prevalence and Treatment Seeking Behaviour of Young Nigerian Adults'. Annals of African Medicine. Vol 5. No2. 82-88. Ayanleke. M. O. 2011. Pregnancy Care in Ilesa. An Unpublished Ph.D Seminar Paper submitted to the Department of Sociology,University of Ibadan, Ibadan, Nigeria Batega, D.W.2004. 'Knowledge, Attitudes and Practices about Malaria treatment and prevention in Uganda: A Literature Review'. 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