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Background: In Nigeria, women too often suffer the consequences of serious obstetric complications that may lead to death. Delay in seeking care (phase I delay) is a recognized contributor to adverse pregnancy outcomes. This qualitative study aimed to describe the health care seeking practices in pregnancy, as well as the socio-cultural factors that influence these actions. Methods: The study was conducted in Ogun State, in south-western Nigeria. Data were collected through focus group discussions with pregnant women, recently pregnant mothers, male decision-makers, opinion leaders, traditional birth attendants, health workers, and health administrators. A thematic analysis approach was used with QSR NVivo version 10. Results: Findings show that women utilized multiple care givers during pregnancy, with a preference for traditional providers. There was a strong sense of trust in traditional medicine, particularly that provided by traditional birth attendants who are long-term residents in the community. The patriarchal c influenced health-seeking behaviour in pregnancy. Economic factors contributed to the delay in access to appropriate services. There was a consistent concern regarding the cost barrier in accessing health services. The challenges of accessing services were well recognised and these were greater when referral was to a higher level of care which in most cases attracted unaffordable costs. Conclusion: While the high cost of care is a deterrent to health seeking behaviour, the cost of death of a woman or a child to the family and community is immeasurable. The use of innovative mechanisms for health care financing may be beneficial for women in these communities to reduce the barrier of high cost services. To reduce maternal deaths all stakeholders must be engaged in the process including policy makers, opinion leaders, health care consumers and providers. Underlying socio-cultural factors, such as structure of patriarchy, must also be addressed to sustainably improve maternal health. Trial registration: NCT01911494
The study was conducted in four Local Government Areas in Ogun State, Nigeria: Ogijo, Yewa South, Imeko-Afon and Remo North (Table 1 and Fig. 1). Ogun State is one of 36 states and is located in the southwest geo-political zone. It covers a total land area of 16,409 km2. It has a projected population of 4.3 million people and the predominant ethnic group is Yoruba. Farming is the main occupation, largely subsistence farming and cash crops of cocoa and kolanut. In the urban and suburban areas, petty trading and blue-collar jobs are the major occupation. Study site characteristics Map of study sites This study is part of a larger initiative aimed at assessing community level interventions for the management of pre-eclampsia and eclampsia in Nigeria. An ethnographic framework was used to gain insight into the social and cultural realities at the community level, as these are thought to influence health seeking behaviours. Data was collected through focus group discussions with pregnant women, recently pregnant mothers, male decision-makers, opinion leaders, traditional birth attendants (TBAs), community health extension workers (CHEWs), nurses and midwives. In addition, interviews were held with local administrative personnel, private medical practitioners, head TBAs, head CHEWs, chief nursing officers, chief medical directors, medical officers, and community leaders (Tables 2 and and3).3). Each focus group discussion and interview was audio-recorded and transcribed. Data analysis was carried out using NVivo version 10. Focus group discussion characteristics Interview characteristics The Health Research and Ethics Committee (HREC) of Olabisi Onabanjo University Teaching Hospital, Sagamu, Nigeria (OOUTH/DA/326/431) and the Clinical Research Ethics Board of the University of British Columbia, Vancouver, Canada (H12-00132), approved the study.
