Asian Journal of Medical Sciences 1(2): 30-32, 2009
ISSN: 2040-8773
© M axwell Scientific Organization, 2009
Submitted Date: July 04, 2009
Accepted Date: July 18, 2009
Published Date: September 10, 2009
Factors Associated with Delay in Seeking Medical Care among Educated Nigerians
1
Comfort O. Chukuezi and 2 Anelechi B. Anelechi
Social Science Unit, Directorate of General Studies, Federal University of Technology,
Owerri, Imo State
Department of Otolaryngology, Imo State University Teaching Hospital, Orlu, Imo State
1
2
Abstract: Seeking m edical attention by the sick is a p ublic health problem . This study o bjective was to
determine the barriers that hinder seeking of adequate medical care among the educated population in a tertiary
institution. By means of a semi-structured questionnaires data was collected in a survey of 355 students and
staff of Federal University of Technology, Owerri between November 2007 and April 2008.. Majority of the
respondents, 254 (71.53%) were in the age group of 20 to 30 years. 49.25% admitted that they see the doctor
immediately they fall sick while 36.06% preferred to go first to a pharmacy and 12.96% to the patent medicine
dealer to buy drugs for self medication without prescription. Only 1.69% opted to consult a priest or go to a
prayer house. 37.18% follow treatment for a similar complaint as first line of treatment. Among barriers and
factors that cause delay are, waiting time to see the doctor 45.71%; delayed attention in the hospital 42.25%;
waiting to see how the illness goes 22.82%; cost of treatment 16.34% and inaccessibility or distance to the
nearest doctor 2.25%. 88.45% of all those surveyed stated that medical facilities in Nigeria were gro ssly
inadequate. Despite the level of education of the respondents, our findings indicate that there is need for proper
health education of the populace to remove these barriers that delay in seeking medical care.
Key w ords: Care, delays, educated, medical, Nigerians, seeking
INTRODUCTION
Delay in seeking medical care is common and
constitutes a major unresolved public health problem
(Christos et al., 2006.) Many factors influence individual
response when they fall sick. These factors could be
mainly personal but can be affecte d by the individual’s
view of his illness; attitude s about his illness; available
health care; cultural and economic factors; and personal
reluctance or will to seek med ical attention. The perceived
severity of the illness, its intensity and frequency of
persistence also tend to force the individual to take steps
to get well or make precise decisions in other to get better.
A survey study was conducted to determine factors that
influence sick people seeking medical care in a tertiary
institution in Nigeria. The primary aim of this study was
to examine the barriers and extent of the delay in seeking
medical care among the educated population when they
fall ill.
MATERIALS AND METHODS
Between November 2007 and April 2008 a survey
was conducted at Federal University of Technology,
Ow erri in Imo State, Nigeria am ong staff and studen ts to
determine their resp onse to seek ing m edical care when
they fall sick. A tertiary institution was chosen
considering the edu cational levels of the respon dents. A
semi-structured questionnaire was used to collec t data
from the staff and students by a multi-stage sampling
technique. 400 questionnaires were sent out. 355(88.75%)
who filled out the questionnaires correctly were admitted
into the study.
RESULTS
Majority of the people surveyed belonged to the age
group of 20 -30 ye ars (Table 1). 175(49.29% ) claimed
that their first response to illness is to see the doctor
immediately, 128(36.06%) admitted that they will go to a
pharmacy to buy drugs while 46(12.96%) will go to a
patent medicine dealer for treatment (Table 2). Very few
6 (1.69%) admitted that they will consult a priest or go to
a prayer house. N one of them adm itted that they w ould
see a native doctor/medicine man. 173(48.73%) opted for
self medication as first
line of treatment w hile
132(37.18%) preferred to follow treatment for a similar
previous com plaint.(T able 3). Of all those surveyed
45.35% adm itted that they always delayed in seeing a
doctor. Among 175 respondents who claimed seeing the
doctor immediately they fall sick, almost half of them
45.71% indicated that it took hou rs to see a doctor in the
hospital (Table 4). These people claimed that it is a
contributing factor in delay in seeking medical care. The
reasons for delay in seein g a do ctor are outlined in Table
5. They include waiting time to see the doctor 45.71%;
Corresponding Author: B.C. Anelechi, Department of Otolaryngology, Imo State University Teaching Hospital, P.M.B. 8,
Orlu, Imo State, Nigeria
30
Asian J. Med. Sci., 1(2): 30-32, 2009
Table 1: Age Distribution
Age Group
No of R espo nden ts
10-20
61
21-30
185
31-40
69
41-50
29
51-60
10
Percentage%
17.18
52.11
19.44
8.17
3.10
Table 2 : What Do You Do First When Sick?
No of R espo nden ts
See a docto r imm ediately
175
Go to a pharmacy
128
Go to a patent medicine dealer
46
Go to a prayer house/priest
6
Go to a native doctor/medicine man 0
Percentage%
49.29 a phar
36.06
12.96
1.69 Go to a
0
response shou ld be to see the doctor immediately. In our
study 175(49.29%) half of the respondents claimed that
they see the doctor immediately they fall sick, but the
majority of them (45.71%) complained that they had to
wait for hours before they see the doctor. The result in
percentage of patients in a survey by Comm onw ealth
Fund International H ealth Policy in (2006) of the waiting
time to see a doctor when sick in developed countries like
USA, UK , Can ada, A ustralia, New Zealand, and Germany
show that 23-58% of those surveyed stated that they we re
able to see a doctor same day; 13-23% were able to see
their doctor next day for treatment while 3-36% had to
wait for 6 days or more to see a doctor. In our study 45.71
% claimed that it took them hours to see a docto r while
14.29% had to stay for days and 3.43% had to wait for a
week or more. In our survey 45.25% admitted that on
their own they always delay to see the doctor when they
are sick w hile 22.82 % w anted to wait for sometime to see
how the sick ness goes. These delay factors lead to late
presentation of patients and worsen ing of their com plaints
and symptom s. Previous stud ies have investigated factors
associated with delay in seeking medical attention when
sick and suggested that a variety of demographic,
behavioral and clinical characteristics acc ount for this
delay (Goldberg et al ., 2000; Ottesen et al., 2004; Khun
and Manderson, 2007). A survey carried out in 2007 by
Comm onw ealth Fund Intern ational Hea lth Policy surveyData collection by Harris International Inc, found out that
Americans still rely on doctors for treatment of serious
medical problems. However it posits that over-the-counter
medications and dietary supplement combined with a “doit-yourself” attitude and reliance on friends, family and
the internet to understand health problems, are making
consum ers more comfortable about treating minor
ailments. The survey also found out that 73% of
Americans would rather treat themselves at home than see
a physician. 77% take over-the-counter medication; 69%
wait to see if the prob lem w ill go away on its own; 43%
consult with a physician; and 38% take prescription
medication. W e foun d in ou r study that those who go to
the pharmacy or patent medicine dealers to procure or buy
drugs made up a total of 49.02%. Despite the educational
status of those surveyed, it was found that these 49.02%
preferred self medication by purchasing drugs without
doctor’s prescription. They attributed their action to high
cost of medication in the hospitals. Those that follow
treatment for similar previous complaint were 132
(37.18% ). Behavioral factors influence out come but other
economic, structura l and institutional factors contribu te to
delays in treatm ent see king (C atharina, 200 3). These
include health facilities, quality of care and time, costs as
well as transportation and ability (or not) to pay for
prescriptions (Catharina, 2003). Only 16.34% of those
we surveyed agreed that cost of treatment caused their
delay in attending a medical facility or seeing a doctor
when they fall sick. Q uality of care, av ailable h ealth
facilities and time taken to see the doctor were strong
factors in delay among the educated Nigerians than
Tab le 3: Firs t Line o f Trea tmen t
Self medication
Fellow treatm ent or similar
previous complaint
Neighbour’s or friend’s advice
Rely o n treatm ent from med ical
books or internet
No response
No of R espo nden ts
173
Percentage%
48.73
132
10
37.18
2.82
0
40
0
11.27
Table 4: how Long Does it Take to See a Doctor?
Nu mb er of res pon dents
Minutes
52
Hou rs
804
Days
25
Weeks
6
No response
12
Table 5: R easons for D elay in Seeing a D octor
Nu mb er of res pon dents
Wait for sometime to
81
see how the illness goes
Lack of wh o to see
4
Dislike of hospitals/doctors
0
Doc tor’s bill/high cost of
58
treatment/lack of money
Inaccessibility or distance
12
from the nearest doctor
Lack of transportation
0
Fear
0
Illness could have been
0
caused by somebody
De lay in atten tion in th e hos pita
l54
No response
150
Percentage%
29.71
5.71
14.29
3.43
6.85
Percentage%
22.82
1.13
0
16.34
2.25
0
0
0
15.21
42.25
delayed attention in the hospital 42.25%; waiting to see
how the illness goes 22.82% ; cost of treatment 16.34%
and inaccessibility or distance to the nearest doctor
2.25%. 88.45% of all the respondents overwhelmingly
admitted that medical facilities in Nigeria were inadequate
for me dical an d hea lth care.
DISCUSSION
There are many barriers to seeking healthcare. These
include economic, transportation, long waiting time at the
clinics; and lack of knowledge of where to go for
affordable health care. Some peop le tend to use
alternative/comp limentary medicine first and then seek
medical help if these practices are not effective (Isa bel et
al., 2006). Delaying presentation at the hospital after the
o n se t o f s y m p to ms h as b een attribute d to
misunderstanding of the seriousness of signs and
symptoms (O’C arroll et al., 2001). M ost individuals
underrate the sev erity of their illness u ntil it gets worse.
Among the educated populace, it is expected that their
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Asian J. Med. Sci., 1(2): 30-32, 2009
transportation and cost of treatment. The individual’s
propensity to utilize health care is determined by the
perceived benefits of a health care. This propensity varies
with individuals (David et. al. 2005). An overwhelming
number of respondents 314 (88.45%) stated tha t health
and medical facilities were grossly inadequate in N igeria
generally. This observation affected their seeking and use
of medical facilities. Lack of confidence in the medical
care provided by these health facilities oftentimes delayed
access to medical care.
Comm onw ealth Fund National Scorecard on U.S. Health
System Performan ce, 2006. W aiting time to see
doctor when sick or need me dical attention, among
sicker adults. www.comm onw ealthfu nd.o rg/.../
W aiting-Time-to-See-Doctor-W hen-Sick-or-NeedMedical-Atten tion---A mon g-Sicker-A dults
David A., N. Kothari; D. Policastro and G. RanaMukkavilli, 2005. Self-care rising, but physicians
still trusted, Prime Connection. Interac. J. Primary
C a r e http:/ / w w w .m e dc o nne c t.c om /final ht m /
journals/prim e.htm
Goldberg, R., J. Yarzebski and L. Darleen et al., 2000.
Decade-long trends and fac tors associated with time
to hospital presentation in patients w ith acute
myocardial inf:rction. The Worcester Heart Attack
Study. Arch. Internal Med., (160): 3217-3223
Isabel, C., G . Isabel, C. Scarinci and L. Harrisson, 2006.
An examination of socio-cultural factors associated
with health and healthcare seeking among Latin
immigrants, J. Imm igrant and M inority H ealth, 8(8):
377-385.
O’C arroll, R.J., K.B . Smith, N.R. Grubb et al., 2001.
Psychological factors associated with delay in
attending hospital following a myocardial infarction.
J. Psychosom. Res., (51): 611-614.
Ottesen, M.M ., U. Dixen and C. Torp-Pederson et al.,
2004. Prehospital delay in acute coronary syndrome
– an analysis of the compon ents of delay. Int. J.
Cardiol., 96: 97-10 3.
Khun, S. and L. M anderson , 2007 . Hea lth seeking and
access to ca re for children w ith susp ected deng ue in
Cambodia; An ethnographic stud y, BM C Public
Health, 7: 262.
CONCLUSION
Despite the educational level of the respondents, we
found that there was need for p roper health educ ation to
inform the populace on appropriate action to take when
they are sick and available facilities for their medical care.
Political commitment by government and implementation
of effective strategies in health care delivery will go a
long way to restore confidence in the populace who need
to use these facilities when they are sick. T his w ill help to
reduce delays and resorting to improper and inadeq uate
facilities for care.
REFERENCES
Catharina, H., 20 03. W hy do the sick no t utilize health
care/ The case of Zam bia, Health E conom ics, 12(9):
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Christos, P., G. Kourlaba, D.B. Paragiotakos and C.
Stefanadis, 2006. Facto rs associated with d elay in
seeking healthcare for hospitalized patients with
acute coronary syndromes: The GREEC S Study,
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