Factors associated with men’s health facility attendance as clients and caregivers in Malawi: a community-representative survey

Abstract

Introduction Men have higher rates of morbidity and mortality across nearly all top ten causes of mortality worldwide. Much of this disparity is attributed to men’s lower utilization of routine health services; however, little is known about men’s general healthcare utilization in sub-Saharan Africa. Methods We analyze the responses of 1,116 men in a community-representative survey of men drawn from a multi-staged sample of residents of 36 villages in Malawi to identify factors associated with men’s facility attendance in the last 12 months, either for men’s own health (client visit) or to support the health care of someone else (caregiver visit). We conducted single-variable tests of association and multivariable logistic regression with random effects to account for clustering at the village level. Results Median age of participants was 34, 74% were married, and 82% attended a health facility in the last year (63% as client, 47% as caregiver). Neither gender norm beliefs nor socioeconomic factors were independently associated with attending a client visit. Only problems with quality of health services (adjusted odds ratio [aOR] 0.294, 95% confidence interval [CI] 0.10—0.823) and good health (aOR 0.668, 95% CI 0.462–0.967) were independently associated with client visit attendance. Stronger beliefs in gender norms were associated with caregiver visits (beliefs about acceptability of violence [aOR = 0.661, 95% CI 0.488–0.896], male sexual dominance [aOR = 0.703, 95% CI 0.505–0.978], and traditional women’s roles [aOR = 0.718, 95% CI 0.533–0.966]). Older age (aOR 0.542, 95% CI 0.401–0.731) and being married (aOR 2.380, 95% CI 1.196–4.737) were also independently associated with caregiver visits. Conclusion Quality of services offered at local health facilities and men’s health status were the only variables associated with client facility visits among men, while harmful gender norms, not being married, and being younger were negatively associated with caregiver visits.

“For a man to go to hospital, then that would be his last option”: A qualitative study exploring men’s experiences, perceptions and healthcare needs in the implementation of Universal Health Coverage in Kenya

“…Beyond biological factors, prevailing masculine ideals influence men's adherence to certain health-related behaviours. Various studies have linked men's behaviours and their underutilization of healthcare to gendered differences and masculine norms perpetuating the narrative of 'Being a man' [17][18][19] The societal pressure to conform to ideal masculine roles, such as being a breadwinner, and the fear of compromising traits like strength and self-reliance contribute to delays in seeking healthcare. Additionally, cultural beliefs and misconceptions about the supernatural causes of diseases influence men's preferences for alternative medicine over formal health services in some instances [18].…”

Interventions to improve men’s engagement in HIV and other key services in sub-Saharan Africa: a scoping review

“…Positive or negative experiences with any health service can impact men’s decision to use HIV services in the future. 23–25 Improved experiences with general health services (not just HIV services) may improve men’s engagement with health systems more broadly, and HIV services specifically.…”