Timor-Leste Health Care Seeking Behaviour Study - Secretaria de ...

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Timor-Leste Health Care Seeking Behaviour Study | 2009Women’s health also influenced decision to space. Married men were articulate about health effectsof not spacing: constant pregnancy and breastfeeding could weaken a woman’s body and lead tomalnutrition, low body weight and vulnerability to illness (see Box 11). Further, breastfeeding whilepregnant could cause sickness in the infant as the milk is perceived to be dirty (foer). Additionally,the uterus could become thin(tipis) from frequent pregnancyBox 11: Effect of not spacing on woman’s healthWhat happens for a husband and wife to beginthinking about birth spacing?First, they think of economy, and second, the mother’scondition. Sometimes the mother’s condition is notgood – delivering a baby every year. If we compare theyield of corn planted in the same field year after year.In the first year it yields well, in the next year the yieldis less because the fertility of the soil had decreased. Itis like this with people also: if a woman gives birthevery year, her condition declines. So a mother shouldthink first and for the sake of her health wait at leasttwo years then have another babyAdolescent male, FGD, Ainaroand labour, infection or wounds(kanek). Adolescent womenmentioned using spacing or familyplanning in order to delaychildbirth where they were afraidof difficult birth or maternaldeath.Many women and some menmentioned that spacing allowedwomen both mobility andsociality, otherwise they wereconfined continuously to thehouse. The effect of this wasdisabling and meant “loss of onearm” (dedicated to holding thebaby; liman ida nee sorin mate tiha ona). 23 Sexuality was also mentioned: if a husband and wife wantto sleep together then they should use a method if they don’t want to become pregnant. Notsleeping together is a matter of secret between husband and wife as it is signifies marital problems.Sleeping separately may be achieved by sleeping children between husband and wife in the samebed. Sexual appetite or desire mentioned as nafsu (in this study usually referenced men) wasmentioned as a reason for using spacing because sleeping separately without using a methodrequired mutual abstinence and a man could not be relied upon to abstain.Health workers were proactive about informing women about spacing during immunisation andinfant weighing, when women present with reproductive-related or other health problems, or arriveto a facility with many unspaced children. Some mentioned that health staff informed women aboutthe risks and benefits of using a method, and advised them to tell their husbands. No informantmentioned being pressured to use contraception. People may be influenced by other people’sstories to start thinking about spacing. A woman may get information about family planning from ahealth centre returning home to re-tell what she learned over and over to other women.4.6 Serious illnessWhen serious illness is present, most people access government health care services and seekmedical treatment. Home treatment is also common, and traditional remedies are also commonlysought. Sick adults usually make their own decision about whether to visit a health facility;spouses are involved in about a third of cases.23 Married man, FGD, Bobonara.45
The HCSBS survey investigated processes and steps that the community follow when dealing withserious illness. Data was gathered on 285 individuals reporting a serious or significant illness in thepast twelve months, approximately equal numbers of men (52.3%) and women (47.7%) aged from 0–94 years. The most commonly reported illnesses were fever (16.3%) and malaria (15.2%). Hometreatment was common, with 63% being given biomedical treatment (often paracetamol, 32%) and28.2% trying a home remedy. Almost one quarter of households (22.4%) reported consulting atraditional healer-shaman(matan dook) for the illnessand 28.8% reported takingtraditional medicine. The useof a traditional healer issubstantially higher than wasreported in answer to anearlier survey question aboutthe range of health providersused (14.9%), but is moreconsistent with thequalitative findings.Almost all of those reporting serious or significant illness (95.4%) visited a health facility, most(67.5%) after one day of sickness. The decision to go to the facility was most commonly made by thesick person (34.3%) or their spouse (30%); sometimes by another household member (13.0%).Facilities visited included subdistrict health centres (35.0%), health posts (20.1%) and SISCa posts(15.9%). Very few reported visiting a private clinic (Table 6).4.7 PreventionTable 6 - Type of facility visited by sick person (HCSBS sample)Facility n (%)Subdistrict government health centre 99 (35.0)Government health post 57 (20.1)SISCa post 45 (15.9)District government health centre 37 (13.1)Government hospital 35 (12.4)Private clinic 6 (2.1)Other 4 (1.4)Total 276 (100.0)Information about preventing disease was passed on mainly by health workers, and by xefe suco.Preventive behaviours by community members focused on avoiding contact with the sick, and theeating implements or sputum of the sick. Informants articulated considerable knowledge abouthygiene and sanitation-related actions for diarrhoea prevention. A range of other health problemswere also identified as preventable but informants almost unanimously claimed they did not seekpreventive health care. Some understood antenatal care as helping avoid difficulties, and hadsought this care. Providers were generally aware of their preventive role and frustrated by the lowlevel of community knowledge and preventive practice. Nearly all providers spoke aboutdelivering antenatal care.In the HCSBS survey, the majority of household heads (87.9%) reported that household membersgenerally washed their hands with soap, boiled water before drinking (84.9%) and almost allhouseholds (97.6%) washed their eating utensils (Table 7). The small proportion of households thatreported they did not have soap (
Page 3 and 4: AcknowledgementsWe acknowledge the
Page 5: ForewordHonourable Minister of Heal
Page 12 and 13: Recommendations for the Ministry of
Page 14 and 15: Section 1 - Introduction1.1 Backgro
Page 16 and 17: 1.3.2 Timor-Leste Survey of Living
Page 18 and 19: Satisfaction with services was diff
Page 20 and 21: households. Within each household,
Page 22 and 23: Once the final set of questions was
Page 24 and 25: for all FGDs as well as for all use
Page 26 and 27: Treatment for the illness was sough
Page 28 and 29: mothers carrying infants the journe
Page 30 and 31: (tau todan) should something go wro
Page 32 and 33: Box 2: Midwife demonstrates care of
Page 34 and 35: 4.2.7 MedicationIn relation to trea
Page 36 and 37: esponsibility may be partly mitigat
Page 38 and 39: with bloody diarrhoea (tee raan) to
Page 40: push, preventing premature pushing
Page 43 and 44: In the previous 12 months, 43.3% of
Page 45: Most informants referred to the nor
Page 49 and 50: antenatal care: weighing pregnant w
Page 51 and 52: drug compliance. 27 Some providers
Page 53 and 54: survey activity with little discern
Page 55 and 56: Figure 7 - Improving access, qualit
Page 57 and 58: Education of women is a particularl
Page 59 and 60: 5.4.4 Recommendations for developme
Page 61 and 62: 27. Beiersmann C, Sanou A, Wladarsc
Page 63 and 64: Appendix 2 - Birth spacing narrativ
Page 65 and 66: Appendix 4 - User-provider interact
Page 67 and 68: Appendix 5 - User blame of provider
Page 70: TIMOR-LESTE HEALTH CARE SEEKING BEH

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